Safety Checklist Program for Schools
DHHS (NIOSH) Publication Number 2004-101
Emergency Action Plan (Template)
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Telephone Bomb Threat Checklist
|INSTRUCTIONS: BE CALM, BE COURTEOUS. LISTEN. DO NOT INTERRUPT THE CALLER.|
|YOUR NAME: __________________________ TIME: _____________ DATE: ________________|
|CALLER’S IDENTITY SEX:|
|Male _____ Female ____ Adult ____ Juvenile ____ APPROXIMATE AGE: _____|
|ORIGIN OF CALL: Local __________ Long Distance ___________ Telephone Booth __________|
|___ Loud||___ Soft||___ Fast||___ Slow||___ Excellent||___ Good|
|___ High Pitch||___ Deep||___ Distinct||___ Distorted||___ Fair||___ Poor|
|___ Raspy||___ Pleasant||___ Stutter||___ Nasal||___ Foul|
|___ Local||___ Not Local||___ Calm||___ Angry||___ Factory||___ Trains|
|___ Foreign||___ Region||___ Rational||___ Irrational||___ Machines||___ Animals|
|___ Race||___ Coherent||___ Incoherent||___ Music||___ Quiet|
|___ Deliberate||___ Emotional||___ Office||___ Voices|
|___ Righteous||___ Laughing||___ Machines||___ Airplanes|
|___ Street||___ Party|
|___ Traffic||___ Atmosphere|
|PRETEND DIFFICULTY HEARING – KEEP CALLER TALKING – IF CALLER SEEMS AGREEABLE TO FURTHER CONVERSATION, ASK QUESTIONS LIKE:
When will it go off? Certain Hour?
If building is occupied, inform caller that detonation could cause injury or death.
Activate malicious call trace: Hang up phone and do not answer another line. Choose same line and dial *57 (if your phone system has this capability). Listen for the confirmation announcement and hang up.
Call Security at __________ and relay information about call.
Did the caller appear familiar with plant or building (by his/her description of the bomb location)? Write out the message in its entirety and any other comments on a separate sheet of paper and attach to this checklist.
Notify your supervisor immediately.