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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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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):

Phone Number:_________________________

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).

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