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October 2003
DHHS (NIOSH) Publication Number 2004-101

Safety Checklist Program for Schools

Emergency Action Plan (Template)

School Checklists logo

DISCLAIMER:

Some of the additional resources listed below were provided by other organizations; they are intended to supplement the occupational safety and health information in this product. NIOSH is not responsible for the contents or accuracy of material obtained from these organizations. Furthermore, mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to Web sites do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Also, NIOSH is not responsible for the content of these Web sites.

 

 

 

 

 


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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 ____/____/____
 

 

 
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