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Safety Checklist Program for Schools

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October 2003
DHHS (NIOSH) Publication Number 2004-101

Emergency Action Plan (Template)

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Fire Emergency

Fire Emergency
When fire is discovered:

• Activate the nearest fire alarm (if installed)
• Notify the local Fire Department by calling .
• 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.
  • The fire is small and is not spreading to other areas.
  • Escaping the area is possible by backing up to the nearest exit.
  • The fire extinguisher is in working condition and personnel are trained to use it.

Upon being notified about the fire emergency, occupants must:

  • Leave the building using the designated escape routes.
  • Assemble in the designated area (specify location):________________________________________________________________
  • Remain outside until the competent authority (Designated Official or designee) announces that it is safe to reenter.

Designated Official, Emergency Coordinator or supervisors must (underline one):

  • Disconnect utilities and equipment unless doing so jeopardizes his/her safety.
  • Coordinate an orderly evacuation of personnel.
  • Perform an accurate head count of personnel reported to the designated area.
  • Determine a rescue method to locate missing personnel.
  • Provide the Fire Department personnel with the necessary information about the facility.
  • Perform assessment and coordinate weather forecast office emergency closing procedures

Area/Floor Monitors must:

  • Ensure that all employees have evacuated the area/floor.
  • Report any problems to the Emergency Coordinator at the assembly area.

Assistants to Physically Challenged should:

  • Assist all physically challenged employees in emergency evacuation.

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