Emergency
Action Plan
Sample Written Program
This sample program has been prepared to provide assistance in compliance with USA OSHA standards
and/or Best Management Practices. It should not be used without consideration of the unique conditions and requirements at each site. It may be necessary to modify the program for your specific needs. You remain under obligation to comply with all applicable standards, and use of this program should not be considered to be a guarantee that compliance with applicable requirements will be achieved.
Emergency Action Plan
COMPANY:
ADDRESS:
I. EMERGENCY
PLAN COORDINATOR
NAME:
TITLE:
DEPARTMENT:
TELEPHONE NO:
II. PREFERRED
MEANS OF REPORTING FIRES AND OTHER EMERGENCIES
Type Emergency Report By
Fire
Explosion
Tornado/Weather
Bomb Threat
Chemical Spill/Leak
Violence
Medical
Other
III.
ELEMENTS
A. Emergency Escape Procedures and
Routes
Emergency escape procedures and
route assignments have been posted in each work area, and
all employees have been trained by supervision in the correct
procedures to follow. New employees are trained when assigned
to a work area. A sample escape procedure and escape route
sheet of the type posted in work areas is given in Appendix
A.
B. Procedure for Employees Who Remain
to Operate Critical Operations Before They Evacuate
The attached sheet (Appendix B)
describes operations, procedures, and personnel required in
order for critical operations to be performed before the assigned
personnel evacuate during emergency situations. A description
of the special training provided is also included.
C. Employee Accountability Procedures
After Evacuations
Each supervisor is responsible for
accounting for all assigned employees, personally or through
a designee, by having all such employees report to a predetermined
designated rally point and conducting a head count. Each assigned
employee must be accounted for by name. All supervisors are
required to report their head count (by name) to the Emergency
Evacuation Coordinator. A summary of the evacuation rally
points, together with the identities of supervisors and assigned
employees who must report to each, is also given in Appendix
A.
D. Rescue and Medical Duties
Specific rescue and medical duties
have been assigned to designated individuals. These personnel
have received special training and instructions for properly
carrying out these assignments. A list of the individuals
assigned and a summary of their training are attached (in
Appendix C) for review.
E. Alarm System
Alarm systems for notifying all
employees in case of an emergency are:
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
When so required by specific OSHA
Standards, the organization will comply with OSHA Standard
1910.165, Employee Alarm Systems.
F. Training
The following personnel have been
trained to assist in the safe and orderly emergency evacuation
of other employees. See also Appendix B.
Name
Title
Work Area
Special Assignment
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Training is provided for employees
when:
1. The plan was initiated
2. Responsibilities change
3. New employees are hired or transferred
IV. EMERGENCY
SHUTDOWN PROCEDURES
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. These assignments
are necessary to ensure proper emergency control.
Assignments
Work Area
Name Job Title
Description of Assignment
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
V. SPECIAL TRAINING
The preceding individuals have received
special instructions and training by their immediate supervisors
to ensure their safety in carrying out the designated assignments.
A training record describing the instructions provided and
the detailed procedures to be followed is maintained in the
Emergency Plan and Fire Protection Plan Coordinator’s Office.
Emergency and Fire Protection Plan
Coordinator:
Name:
Date:
____________________________________________________
____________________________________________________
VI. EMPLOYEE
ACCOUNTABILITY PROCEDURES FOLLOWING AN EMERGENCY EVACUATION
Each supervisor is responsible for
accounting for each assigned employee following an emergency
evacuation. This will be accomplished by performing the procedures
established for such an eventuality.
VII. EMPLOYEE ACCOUNTABILITY
1. Rally points have been established
for all evacuation routes and procedures. These points are
designated on each posted work area escape route.
2. All work area supervisors and
employees must report to their designated rally points immediately
following an evacuation.
3. Each employee is responsible
for reporting to his or her supervisor so that an accurate
head count can be made. Supervisors will check off the names
of all those reporting and will report those not checked off
as missing to the Emergency Evacuation Coordinator.
4. The Emergency Evacuation Coordinator
will be located at one of the following locations:
A. Primary Location:
B. Secondary Location:
5. The Emergency Evacuation Coordinator
will determine the method to be utilized to locate missing
personnel.
VIII. RESCUE AND MEDICAL
DUTIES
It may become necessary in an emergency
to rescue personnel and perform some specified medical duties,
including first-aid treatment. All employees assigned to perform
such duties will have been properly trained and equipped to
carry out their assigned responsibilities properly and safely.
Assignments
Special
Name
Location Assignment
Training Provided
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Special Instructions and Procedures
All personnel performing emergency
rescue and medical duties must follow these instructions:
1.
2.
3.
4.
5.
6.
Appendix A.
A summary of the evacuation rally
points, together with the identities of supervisors and assigned
employees who must report to each.
A sample escape procedure and escape
route sheet of the type posted in work areas.
Appendix B
Describes operations, procedures,
and personnel required in order for critical operations to
be performed before the assigned personnel evacuate during
emergency situations. A description of the special training
provided is also included.
Appendix C
Specific rescue and medical duties
have been assigned to designated individuals. These personnel
have received special training and instructions for properly
carrying out these assignments. A list of the individuals
assigned and a summary of their training are attached for
review.