Emergency Action Planner

Emergency Action Planner
Date*

MonthDayYear
Date
Project or Site Name*
Project or Site Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State Project is In
ex: Texas
County the Project is In
ex: Comal
GPS Coordinates if no Address
ex: 29.78125053660635, -98.46360044591945
Your Name*

First NameLast Name
Your Email*
example@example.com
Emergency Phone number
ex: 911
Sheriff/Police Dispatch phone Number
Nearest Hospital Name, Number, and Address
Nearest Fire Department Name & Number
Site Manager(s)
Safety Manager(s)
EMERGENCY ACTION PLAN
Scope
This Plan covers the designated actions the Company and employees must take to ensure employee safety from fire and other emergencies.
Evacuation
Muster Points

In case of an emergency on this site, all workers must exit away from the emergency and toward the Primary or Secondary muster point.
Primary Muster Point:
Secondary Muster Point:
Evacuation and Exit Pathway Drawing(s)

For sites that require visual instruction regarding exit routes and emergency muster points, a site emergency evacuation plan drawing shall be developed and attached here:
File Upload/Hospital Driving Directions

Cancelof
Drawing Board
Emergency Procedures
Employees and workers who remain in the emergency area to operate critical site functions and/or manage the emergency shall follow the following procedures. If the procedures loose their effectiveness, new procedures shall be developed by using the form [edit] function:
1. Identify the tasks associated with response personnel actions
2. Identify the hazards associated with with the above response personnel tasks
3. Identify the Personal Protective Equipment (PPE)required for response personnel
4. Identify means of communication that shall be used by emergency workers
5. What are the emergency rescue plans in case emergency workers need to be rescued?
STOP WORK
1. It is the obligation of every employee, contractor, and visitor to STOP observed or assumed unsafe acts, conditions, or behaviors when they are observed or discovered. If you see a risky situation, you own that situation until you stop the cycle of risk.
2. In addition, it is the obligation of every employee, contractor, and visitor to STOP and exit the immediate emergency when something does not go as planned, and reassess and replan before reentering the emergency.
Alarm System
The designated employee Alarm for this site is:
ex: horn, car horn, siren, flashing beacon, etc.
Site management shall implement an employee alarm system or tool that provides adequate warning for necessary emergency action for reaction time for safe escape of employees from the workplace or the immediate work area, or both.

The employee alarm shall be capable of being perceived above ambient noise or light levels by all employees in the affected portions of the workplace. Tactile devices may be used to alert those employees who would not otherwise be able to recognize the audible or visual alarm.

The employee alarm shall be distinctive and recognizable as a signal to evacuate the work area.
Should be Empty:

Emergency Action Planner

EMERGENCY ACTION PLAN

Scope

Evacuation

Emergency Procedures

STOP WORK

Alarm System