Emergency Action Plan - Template, Sample Form Online Pro · US-law
✓ Valid in United States · drafted to comply with local law
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EMERGENCY ACTION PLAN
________
Principal Workplace Address: ________
State of ________
Effective Date: ________
§ I. EMERGENCY PERSONNEL CONTACT INFORMATION.
1. The following individual shall serve as the designated Employer emergency coordinator responsible for administering this Plan and the person to be contacted by employees who require further information about the Plan or an explanation of their duties under it (29 C.F.R. § 1910.38(c)(5)):
________
________
________
________
2. The following external emergency services may be contacted as appropriate. In all life-threatening emergencies, dial 911 first.
-- Emergency (police, fire, medical): 911
-- Local non-emergency line: ________
-- Poison Control Center: 1-800-222-1222
-- Building management / facility security: ________
§ II. ALERTS.
3. In the event of an emergency, employees shall be alerted by one or more of the following means, in accordance with the alarm system requirements of 29 C.F.R. § 1910.38(d) and § 1910.165:
-- Alarm bell or buzzer
-- Public address system
-- Text alert
-- Phone call
-- Email notification
-- Verbal communication by designated leaders
4. The primary means of alerting employees at this workplace shall be: ________.
§ III. EVACUATION ROUTES, ASSEMBLY, AND ACCOUNTING.
5. In the event of an emergency requiring evacuation, employees shall evacuate in accordance with the following procedures and the designated exit routes maintained under 29 C.F.R. § 1910.38(c)(1):
________
6. After an emergency evacuation, employees shall gather at the following primary assembly location, and the following secondary assembly location if the primary is unsafe or inaccessible:
Primary: ________
Secondary: ________
7. The procedure for accounting for all employees after an emergency evacuation, as required by 29 C.F.R. § 1910.38(c)(3), is as follows:
________
§ IV. MEDICAL EMERGENCIES.
8. Call appropriate medical emergency personnel, such as paramedics, an ambulance, or the fire department, by dialing 911.
9. Provide the following information to emergency medical personnel:
-- Nature of the medical emergency
-- Location of the emergency (address, building, room number)
-- Your name and the telephone number from which you are calling
10. Do not move the victim unless absolutely necessary to prevent further injury. Only employees trained and authorized in first aid or cardiopulmonary resuscitation shall render aid, consistent with 29 C.F.R. § 1910.151. Designated trained first-aid responder(s): ________.
§ V. FIRE EMERGENCIES.
11. If a fire is discovered, pull the fire alarm, if available and not already activated, to warn occupants to evacuate. Then dial 911 to alert the fire department. Provide the following information:
-- Business name and street address
-- Nature and source of fire
-- Fire location (building and floor)
-- Type of fire alarm (e.g., detector, pull station, sprinkler waterflow)
-- Location of fire alarm (building and floor)
-- Name of person reporting the fire
-- Telephone number for return call
12. An employee may attempt to fight an incipient-stage fire ONLY when ALL of the following conditions are met:
-- The fire department has been notified.
-- The fire is small and not spreading to other areas.
-- The employee has been trained in the use of portable fire extinguishers as required by 29 C.F.R. § 1910.157(g).
-- Escaping the area is possible by backing up to the nearest exit.
13. Only the following individual(s), who have been trained in accordance with 29 C.F.R. § 1910.157, are authorized to use portable fire extinguishers to attempt to extinguish incipient fires before evacuating. All other employees shall evacuate immediately:
________
14. Upon being notified of a fire emergency, employees must:
-- Leave the building using the designated escape routes posted at the following location: ________.
-- Assemble in the designated area: ________.
-- Remain outside until the competent authority announces that it is safe to re-enter.
15. Employees shall adhere to the following evacuation procedures:
-- Evacuate the building along the evacuation routes to the primary assembly area outside.
-- Redirect building occupants to stairs and exits away from the fire.
-- Do not use elevators.
§ VI. SEVERE WEATHER AND NATURAL DISASTERS.
16. In the event of a tornado, abide by the following procedures:
-- Seek shelter inside, in a small interior room on the lowest floor without windows, in a hallway on the lowest floor away from doors and windows, and/or in a room constructed of reinforced concrete, brick, or block with no windows.
-- Stay away from outside walls and windows.
-- Use arms to protect the head and neck.
-- Remain sheltered until the tornado threat is announced to be over.
17. In the event of an earthquake, abide by the following procedures:
-- Keep away from overhead fixtures, windows, filing cabinets, and electrical power.
-- All employees should drop to the ground, take cover under sturdy furniture (such as a desk or table), and hold on until the shaking stops.
-- Once it is safe to do so, evacuate the building using the designated evacuation routes and assembly points.
-- Remain out of the building until it has been assessed for structural damage, gas leaks, fires, and other hazards.
18. In the event of a flood, abide by the following procedures:
-- Monitor weather forecasts and flood alerts issued by local authorities.
-- Move valuable equipment to higher ground and secure loose objects.
-- If possible, shut off utilities such as electricity, gas, and water to prevent further damage and reduce safety risks.
-- Secure important documents, data, and equipment in waterproof containers or elevated areas.
-- If available and time allows, deploy sandbags or flood barriers to protect entrances and vulnerable areas.
-- If evacuation is necessary, follow the designated evacuation routes to higher ground or a safe location outside of the flood zone.
19. In the event of a hurricane or tropical storm, abide by the following procedures:
-- Monitor weather updates and hurricane warnings issued by relevant authorities.
-- Secure outdoor items and reinforce windows and doors.
-- Determine whether evacuation is necessary based on the severity of the hurricane and local evacuation orders.
-- If evacuation is necessary, follow the designated evacuation routes, avoiding flood-prone areas and potential hazards.
§ VII. EXTENDED POWER LOSS.
20. In the event of an extended power loss to a facility, the following precautionary measures should be taken depending on the location and environment of the facility:
§ VIII. ACTIVE SHOOTER AND WORKPLACE VIOLENCE.
21. An “active shooter” is an individual actively engaged in killing or attempting to kill people in a confined and populated area, typically using firearms.
22. During an active shooter event, follow the Run, Hide, Fight procedure:
-- Run: If possible, evacuate the building immediately and flee to a safe location outside the shooter’s line of sight.
-- Hide: If evacuation is not possible, seek shelter in a secure location, lock or barricade doors, turn off lights, and silence electronic devices.
-- Fight: As a last resort, and only when life is in imminent danger, use improvised weapons and aggressive action to incapacitate or disarm the shooter and protect fellow employees.
23. Upon being informed of an active shooter threat, initiate the following lockdown procedures:
-- Secure all entry points, lock doors, and turn off lights to create barriers and reduce the shooter’s access to potential targets.
-- Silence cell phones and refrain from making noise that could alert the shooter to employees’ locations.
24. Contact emergency services as soon as it is safe to do so to report the active shooter situation, providing details such as the location, a description of the shooter, the number of shooters if more than one, the number and type of weapons, and any known injuries.
25. Remain in a safe location until law enforcement officers provide clearance and instructions to evacuate.
26. Follow law enforcement instructions carefully and avoid sudden movements that could be perceived as a threat.
§ IX. BOMB THREAT.
27. Upon receiving a bomb threat, the credibility of the threat should be evaluated based on the specific details provided, such as the stated location of the device, the time of detonation, and the method of delivery.
28. All relevant information should be documented, including the exact wording of the threat and any identifying characteristics of the caller or message.
29. Immediately notify the proper authorities, such as local law enforcement, the bomb squad, and building management.
30. Do not touch or disturb any suspicious object if found; instead, report it to law enforcement for further investigation. Do not use cell phones or two-way radios in the immediate vicinity of a suspected device.
31. If the decision is made to evacuate, direct employees to evacuate using the designated evacuation routes and to assemble at a point located a safe distance away from the building.
§ X. CHEMICAL OR HAZARDOUS MATERIAL SPILL.
32. In the event of a chemical or hazardous material spill or release, immediately alert all personnel in the affected area and evacuate to a safe location upwind of the spill, consistent with the Employer’s obligations under 29 C.F.R. § 1910.1200 and, where applicable, 29 C.F.R. § 1910.120.
33. Notify the appropriate emergency response personnel and provide the following information:
-- Business name and street address
-- Type and quantity of material spilled or released
-- Location of the spill (building and floor)
-- Nature of any injuries or exposures
-- Name and telephone number of the person reporting
34. Do not attempt to clean up the spill unless properly trained and equipped with the appropriate personal protective equipment.
35. Seal off the affected area to prevent further exposure and remain clear until the competent authority announces that it is safe to re-enter. Safety Data Sheets (SDS) for hazardous chemicals present at the workplace are maintained at: ________.
§ XI. CRITICAL OPERATIONS.
36. During certain emergency situations, it will be necessary for the following specially assigned personnel to remain at their work areas to perform critical operations before evacuating, as contemplated by 29 C.F.R. § 1910.38(c)(2):
________
________
§ XII. TRAINING AND REVIEW.
37. The Employer shall review this Plan with each employee at the time of initial assignment, whenever the employee’s responsibilities under the Plan change, and whenever the Plan is changed, in accordance with 29 C.F.R. § 1910.38(f).
38. The Plan shall be reviewed and updated by the Employer no less frequently than: ________.
§ XIII. MODIFICATIONS.
39. The Employer reserves the right to amend, modify, or revise this Plan at any time in its sole discretion.
40. If substantive changes are made to the Plan, employees will be notified in writing of such changes.
§ XIV. NO CONTRACT; AT-WILL EMPLOYMENT.
41. This Plan is a safety guide intended to comply with applicable occupational safety and health laws and does not create any contractual obligation upon the Employer or any employee, nor any express or implied contract of employment. Nothing in this Plan alters the at-will nature of employment, where applicable, or supersedes any existing written employment agreement, which shall control in the event of any conflict.
42. If any provision of this Plan is held invalid or unenforceable, the remaining provisions shall continue in full force and effect. This Plan shall be governed by and construed in accordance with the laws of the State of ________ and applicable federal law.
§ XV. ACKNOWLEDGMENT.
43. By signing below, the employee acknowledges and confirms that they have received, read, and understood this Plan and agree to comply with all provisions herein.
44. The employee acknowledges and understands that this Plan is a guide and does not create contractual obligations upon the parties, and that any existing employment contract shall prevail.
EXECUTION.
IN WITNESS WHEREOF, the undersigned Employee acknowledges their receipt and understanding of this Plan:
_________________________________
Employee Signature
________
Employee Name (printed)
________
Title / Department
________
Date
Acknowledged on behalf of Employer:
_________________________________
Authorized Representative Signature
________
Name and Title
________
Date
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