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Emergency Action Plan Template

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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 : (________________)

MEDICAL EMERGENCY • Call medical emergency phone number (check applicable): Paramedics Ambulance

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