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October 2003
DHHS (NIOSH) Publication Number 2004-101

Safety Checklist Program for Schools

Emergency Action Plan (Template)

School Checklists logo

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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.

Structure Climbing/Descending Emergencies

 
List structures maintained by site personnel (tower, river gauge, etc.):
No. Structure Type Location (address, if applicable) Emergency Response Organization* (if available within 30-minute response time)
       
       
       
       
       
Emergency Response Organization(s):

Name:_________________________ Phone Number:_________________________


Name:_________________________ Phone Number:_________________________

Attach Emergency Response Agreement if available)

 

* - N/A. If no Emergency Response Organization available within 30-minute response time additional personnel trained in rescue operations and equipped with rescue kit must accompany the climber(s).

 
 
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