Employee Emergency Action Plan

Information you will need

• What’s the facility's name?
• What’s the facility's address?
• On what date was this document prepared?
• On what date was the emergency personnel information filled out?
• What’s the designated responsible official's name?
• What’s the designated responsible official's phone number?
• What’s the emergency coordinator's name?
• What’s the emergency coordinator's phone number?
• What’s the first area/floor monitor's name?
• What’s the first area/floor monitor's phone number?
• What’s the first monitor's designated area or floor?
• What’s the second area/floor monitor's name?
• What’s the second area/floor monitor's phone number?
• What’s the second monitor's designated area or floor?
• What's the phone number of the first assistant for the physically challenged?
• What's the name of the second assistant for the physically challenged?
• What's the phone number of the second assistant for the physically challenged?
• What’s the paramedic's phone number?
• What’s the ambulance's phone number?
• What’s the police's phone number?
• What’s the federal protective service's phone number?
• What’s the phone number for security?
• What’s the building manager's phone number? (if applicable)
• What's the name of the other emergency contact?

…and 176 more fields in the PDF.

Completed by the employee and the provider.