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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.


This section contains ready-to-fill templates for designing an emergency action plan for a facility which covers: Emergency Personnel, Evacuation Routes, Emergency Phone numbers, Utility Company Emergency Contacts, Emergency Reporting and Evacuation Procedures for Medical, and Fire emergencies, Extended Power Loss, Chemical Spill, Structure Climbing/Descending emergencies, Bomb-Threat Checklist, Severe Weather and Natural Disaster emergencies. (Developed by Lewis Payton, Auburn University, AL; used with permission.)

This template is presented in both HTML and PDF format. Adobe’s Acrobat Reader MUST be installed in order to view the PDF version. To install the latest version of Adobe’s Acrobat Reader, click on the following link, and follow the instructions on the page.

Should an Internet connection not be available, version 4.05 of the Acrobat Reader is included on this CDROM in the Win95 Directory. On Microsoft Windows® systems, use the “My Computer” icon to navigate to the Checklist CDROM, and then double click on it’s icon. The Win95 directory should then be visible. Double click on that icon. Two files should now be visible. To install version 4.05 of the Acrobat Reader, ensure all other programs are closed, then double click on the file named “ar405eng” (without the quotes) and follow the instructions.


The Emergency Action Plan (Template) contains __ pages, each of which is linked to below. The HTML versions of these pages have been formatted so that they can be printed out. Please note that some of these pages might print out on more than one sheet of paper due to formatting issues. At the bottom of the Contents is a link to a PDF version of this Template (Acrobat Reader must be installed to view this file).


This is a Microsoft Word® version of the Emergency Action Plan (Template) provided for customization to individual facility needs. Should the web browser not launch Word® or otherwise fail to access this file, it can be found on the Checklist CDROM by double clicking on the “My Computer” icon on the desktop, then double clicking on the Checklist CDROM icon (usually drive D: or E:), and then double clicking on the “school” folder, and finally double clicking on the “emrgact” folder. The file named “emergact.doc” (without quotes) is the Microsoft Word® version.

This is an Adobe Portable Document Format (PDF) version of the Emergency Action Plan (Template) suitable for printing.