NIOSH Safety Checklist Program for Schools

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: (_______________)

ASSISTANTS TO PHYSICALLY CHALLENGED (If applicable):

Name:______________________________________ Phone: (________________)

Date ____/____/____