Nature of medical emergency, b. : Wyoming Emergency Response Plan â¦ Responsibilities change . LISTEN. Upon being notified about the fire emergency, occupants must: Leave the building using the designated escape routes. ² Fluids prevent dehydration. ADDRESS . Emergency Response Planning Template for Public Drinking Water Systems Page 4 Section 2. Any suggestions, comments, or questions should be directed to Individualâs Name or Position. 1. SEVERE WEATHER AND NATURAL DISASTERS Tornado: When a warning is issued by sirens or other means, seek inside shelter. OJ QJ ]^J aJ! Introduction. YOUR NAME: __________________________ TIME: _____________ DATE: ________________ CALLER'S IDENTITY SEX: Male _____ Female ____ Adult ____ Juvenile ____ APPROXIMATE AGE: _____ ORIGIN OF CALL: Local __________ Long Distance ___________ Telephone Booth __________ VOICE CHARACTERISTICS SPEECH LANGUAGE ___ Loud ___ High Pitch ___ Raspy ___ Intoxicated ___ Soft ___ Deep ___ Pleasant ____________ Other ___ Fast ___ Distinct ___ Stutter ___ Slurred ___ Slow ___ Distorted ___ Nasal ____________ Other ___ Excellent ___ Fair ___ Foul ___ Good ___ Poor __________ Other ACCENT MANNER BACKGROUND NOISES ___ Local ___ Foreign ___ Race ___ Not Local ___ Region ___ Calm ___ Rational ___ Coherent ___ Deliberate ___ Righteous ___ Angry ___ Irrational ___ Incoherent ___ Emotional ___ Laughing ___ Factory ___ Machines ___ Music ___ Office ___ Machines ___ Street ___ Traffic ___ Trains ___ Animals ___ Quiet ___ Voices ___ Airplanes ___ Party ___ Atmosphere BOMB FACTS PRETEND DIFFICULTY HEARING KEEP CALLER TALKING IF CALLER SEEMS AGREEABLE TO FURTHER CONVERSATION, ASK QUESTIONS LIKE: When will it go off? During some emergency situations, it will be necessary for some specifically assigned and properly trained employees to remain in work areas that are being evacuated long enough to perform critical operations. Open the windows a little for fresh air to avoid carbon monoxide poisoning. - Raise the hood after the snow stops falling. Ñ The Department Name emergency plan is the responsibility of Individualâs Name or Position. Follow the recommended primary or secondary evacuation routes. When there is a hazard within a building such as a fire or chemical spill, occupants within the building should be evacuated or relocated to safety. - Stuff towels or rags in cracks under doors. Use arms to protect head and neck. Name of Spill Cleanup Company:_______________________________ Phone Number:_____________________________________________ Evacuate building as necessary When a Small Chemical Spill has occurred: Notify the Emergency Coordinator and/or supervisor (select one). This template is for organisations to write an emergency plan. Perform an accurate head count of personnel reported to the designated area. (Organization Name) Pandemic Response Plan Original Date: 3/15/20 Revised Date: N/A Pandemic Response Plan for (Organization Name) Overview A âPublic health emergencyâ is the occurrence or imminent threat of an illness, health condition, or widespread exposure to an infectious or toxic agent that poses a significant risk of substantial Continue to monitor local TV and radio stations for instructions. If outdoors: Find a dry shelter. In case emergency situation will not permit any of the personnel to remain at the facility, the designated official or other assigned personnel shall notify the appropriate _______________ offices to initiate backups. DO NOT INTERRUPT THE CALLER. If a tornado warning is broadcast, everyone should be moved to the strongest part of the building and away from exterior glass. This Emergency Recovery Plan was designed to assist you in the development of your Emergency Recovery Plan.. If no Emergency Response Organization available within 30-minute response time additional personnel trained in rescue operations and equipped â¦ Attempt first aid ONLY if trained and qualified. This form is also available in MS Word format. DATE . Document type. Evacuation. Our role in a Civil Defence emergency. Designated Official, Emergency Coordinator or supervisors must (underline one): Disconnect utilities and equipment unless doing so jeopardizes his/her safety. Thank you Capt. Emergency action plan template in Word and Pdf formats Toggle navigation Provide the Fire Department personnel with the necessary information about the facility. You are free to share [â¦] Leave areas that might be affected by storm tide or stream flooding. TRP's Emergency Response Plans incorporate site-specific actions and consistent best-practice procedures that significantly improve quality, accessibility, and accuracy of response planning programs. The following offices should be contacted: Name/Location:________________________________ Telephone Number:_____________________________ Name/Location:________________________________ Telephone Number:_____________________________ Name/Location:________________________________ Telephone Number:_____________________________ TRAINING The following personnel have been trained to ensure a safe and orderly emergency evacuation of other employees: Facility: Name Title Responsibility Date ( ) * + 3 H I J R S T X t w Ø Ü ì î A B òäÙÎÙÀÙÎ¬|¬qf[q[O[q[Oq >*CJ OJ QJ ^J aJ CJ OJ QJ ^J aJ CJ" OJ QJ ^J aJ" CJ OJ QJ ^J aJ #56CJ! Emergency Response Plan (Guidance Document) Purpose: The Internal emergency response plan is designed to facilitate the safe evacuation of all occupants from the _____(location) in the event of fire or other internal emergency. Fire sprinkler system Standpipes Potable water lines Toilets Add propylene-glycol to drains to prevent traps from freezing Equipment that contain fluids that may freeze due to long term exposure to freezing temperatures should be moved to heated areas, drained of liquids, or provided with auxiliary heat sources. The Fire Emergency Plan (FEP) is a plan that contains information on the types of fire safety measures that are provided in designated premises and includes floor layout plans and fire evacuation procedures. If you are on high ground, away from the coast and plan to stay, secure the building, moving all loose items indoors and boarding up windows and openings. EMERGENCY PHONE NUMBERS FIRE DEPARTMENT: ________________ PARAMEDICS: _______________ AMBULANCE: _______________ POLICE: ________________ FEDERAL PROTECTIVE SERVICE: ________________ SECURITY (If applicable): _________________ BUILDING MANAGER (If applicable): ________________ UTILITY COMPANY EMERGENCY CONTACTS (Specify name of the company, phone number and point of contact) ELECTRIC: _____________________ WATER: _______________________ GAS (if applicable): __________________________ TELEPHONE COMPANY: _______________________ Date: ___/____/_____ EMERGENCY REPORTING AND EVACUATION PROCEDURES Types of emergencies to be reported by site personnel are: MEDICAL FIRE SEVERE WEATHER BOMB THREAT CHEMICAL SPILL STRUCTURE CLIMBING/DESCENDING EXTENDED POWER LOSS OTHER (specify)___________________________________ (e.g., terrorist attack/hostage taking) MEDICAL EMERGENCY Call medical emergency phone number (check applicable): Paramedics Ambulance Fire Department Other Provide the following information: a. 7. Chain of Command â Lines of Authority The first response step in any emergency is to inform the person at the top of this list, who is responsible for managing the emergency and making key decisions. Contents. If outdoors: Climb to high ground and stay there. Stay indoors! Emergency Response Plan should be brought forward to your Authority in Charge (Board of Directors, Executive Director, Operator, etc) for discussion and proper implementation into action. Flood: If indoors: Be ready to evacuate as directed by the Emergency Coordinator and/or the designated official. Keep away from overhead fixtures, windows, filing cabinets, and electrical power. Report any problems to the Emergency Coordinator at the assembly area. Buildings that require the appointment of FSM however, not only need the FEP but also the In-Place-Protection (IPP) plâ¦ Ó Assignments: Work Area Name Job Title Description of Assignment Personnel involved in critical operations may remain on the site upon the permission of the site designated official or Emergency Coordinator. Collins for allowing us to share this valuable contribution to â¦ 5. Emergency Response Plan Word Template Free Download sites01.lsu.edu | For effective response to an action on an emergency situation it is advisable to have a plan in place and brief the staff about it so they will not be scared or confused in emergencies. 38.15 KB. Call a local spill cleanup company or the Fire Department (if arrangement has been made) to perform a large chemical (e.g., mercury) spill cleanup. What is the rationale to convert existing Fire Emergency Plan (FEP) to the Emergency Response Plan (ERP)? Assistants to Physically Challenged should: Assist all physically challenged employees in emergency evacuation. This template can be used by small wastewater systems to help them develop such plans. Revisions will be made as needed throughout the year. Write out the message in its entirety and any other comments on a separate sheet of paper and attach to this checklist. Ò EMERGENCY ACTION PLAN. Form Description; RCAP Emergency Response Plan Template for Small Community Water Systems - Rural Community Assistance Partnership (RCAP) emergency response planning template for use by small community water systems and non-transient non-community water systems, including instructions. CHEMICAL SPILL The following are the locations of: Spill Containment and Security Equipment: ___________________________ Personal Protective Equipment (PPE): MSDS:_____________________________________________________ When a Large Chemical Spill has occurred: Immediately notify the designated official and Emergency Coordinator. In different product and service providers, Facility Name: _____ ... (Attach Emergency Response Agreement if available) * - N/A. TELEPHONE BOMB THREAT CHECKLIST INSTRUCTIONS: BE CALM, BE COURTEOUS. The Guidance document is in WORD format so that one can âcut and pasteâ in order to âfill in the blanks.â Any Questions, please contact Occupational Safety and Health. 5CJ! Assembly points Site personnel should know at least two evacuation routes. Emergency contact plan â parents and caregivers. &. Ð 1. - Tie a colored cloth to your antenna or door. Fire and potable water piping should be checked for leaks from freeze damage after the heat has been restored to the facility and water turned back on. Download or preview 6 pages of PDF version of Emergency action plan template (DOC: 159.2 KB | PDF: 83.3 KB ) for free. Emergency Response Plan. Attend to injured personnel and call the medical emergency number, if required. If car stalls, abandon it immediately and climb to a higher ground. It includes: It will lower your body temperature. Notify your supervisor immediately. Make sure the exhaust pipe is not blocked. Run the motor about ten minutes each hour. TABLE OF CONTENTS . Moor any boats securely, or move to a safe place if time allows. Deal with the spill in accordance with the instructions described in the MSDS. EMERGENCY SHUTDOWN PROCEDURES . A hurricane watch issued when a hurricane becomes a threat to a coastal area. If the fire alarm is not available, notify the site personnel about the fire emergency by the following means (check applicable): Voice Communication Phone Paging Radio Other (specify) Fight the fire ONLY if: The Fire Department has been notified. Emergency Response Plan Templates & â¦ ³ 7. INTRODUCTION Brief description of company. Other incidents such as a bomb threat or receipt of a suspicious package may also require evacuation. âAn emergency response plan shall be developed and implemented to handle anticipated emergencies prior to the commencement of emergency response operations. Ù Emergency Action Plan (Template) tc \l2 "Emergency Action Plan (Template) EMERGENCY ACTION PLAN for Facility Name: ____________________ Facility Address: ___________________ DATE PREPARED: ___/_____/______ EMERGENCY PERSONNEL NAMES AND PHONE NUMBERS DESIGNATED RESPONSIBLE OFFICIAL (Highest Ranking Manager at _____________site, such as __________, ___________, or ____________): Name: Phone: (________________) EMERGENCY COORDINATOR: Name: Phone: (______________) AREA/FLOOR MONITORS (If applicable): Area/Floor: Name: Phone: (_______________) Area/Floor: Name: Phone: (_______________) ASSISTANTS TO PHYSICALLY CHALLENGED (If applicable): Name: Phone: (_______________) Name: Phone: (________________) Date ____/____/____ EVACUATION ROUTES Evacuation route maps have been posted in each work area. Unless trained to use it formats Toggle navigation a copy of this document is available in Word. 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