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Safety Checklist Program for Schools

October 2003
DHHS (NIOSH) Publication Number 2004-101

Emergency Action Plan (Template)

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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.

Medical Emergency

Call medical emergency phone number (check applicable):

( ) Paramedics_______________________________

( ) Ambulance________________________________

( ) Fire Department___________________________

( ) Other____________________________________

Provide the following information:

a. Nature of medical emergency,

b. Location of the emergency (address, building, room number), and

c. Your name and phone number from which you are calling.

Do not move victim unless absolutely necessary.

Call the following personnel trained in CPR and First Aid to provide the required assistance prior to the arrival of the professional medical help:

Name:____________________________Phone:___________________

Name:____________________________Phone:___________________

If personnel trained in First Aid are not available, as a minimum, attempt to provide the following assistance:

  1. Stop the bleeding with firm pressure on the wounds (note: avoid contact with blood or other bodily fluids).
  2. Clear the air passages using the Heimlich Maneuver in case of choking.

In case of rendering assistance to personnel exposed to hazardous materials, consult the Material Safety Data Sheet (MSDS) and wear the appropriate personal protective equipment. Attempt first aid ONLY if trained and qualified.


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  • Page last reviewed: June 6, 2014
  • Page last updated: June 6, 2014
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