Safety Checklist Program for Schools
October 2003
DHHS (NIOSH) Publication Number 2004-101
Emergency Action Plan (Template)
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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: (________________) |
Date ____/____/____ |