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EMERGENCY PREPAREDNESS TEMPLATE

Health Facilities Administration-Licensing 6/11/2015 Page 1 EMERGENCY PREPAREDNESS TEMPLATE *This TEMPLATE is designed to help facilities keep track of EMERGENCY PREPAREDNESS information. The fields can be typed in online or the form can be printed out and done by hand. To save the information, print when done filling out, then do a save as and rename document. FACILITY: LICENSE #: DATE OF ORIGINAL DOCUMENT: REVISION DATE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Authority Having Jurisdiction: APPROVAL DATE: Authority Having Jurisdiction SIGNATURE: Health Facilities Administration-Licens

EMERGENCY PREPAREDNESS TEMPLATE *This template is designed to help facilities keep track of emergency preparedness information. The fields can be typed in online or the form can be printed out and done by ... Radiological Release Other (specify) Chemical Hazards Within the Facility Outside of the Facility Other (specify) ...

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