SAMPLE EMERGENCY RESPONSE PROCEDURE

□ PLAN TO STAY IN BUSINESSIf this location is not accessible we will operate from location below:

______

Business NameBusiness Name

______

AddressAddress

______

City, StateCity, State

______

Telephone NumberTelephone Number

The following person is our primaryIf the person is unable to manage the

crisis manager and will serve as thecrisis, the person below will succeed

company spokesperson in anin management:

emergency.

______

Primary Emergency ContactSecondary Emergency Contact

______

Telephone NumberTelephone Number

______

Alternate NumberAlternate Number

______

E-mailE-mail

□ EMERGENCY CONTACT INFORMATION

Dial 9-1-1 in an Emergency Corporate HQ Contact Info/ Tel#

______

Non-Emergency Police/Fire

______

Insurance Provider / Tel #

SAMPLE EMERGENCY RESPONSE PROCEDURE

□ EMERGENCY PLANNING TEAM

The following company personnel have participated in emergency planning and crisis management and can be consulted for assistance:

  • ______
  • ______
  • ______
  • ______
  • ______

□ WE PLAN TO COORDINATE WITH OTHERS

The following companies have participated on our emergency planning team and can be contacted for mutual aid:

  • ______
  • ______
  • ______
  • ______
  • ______

□ OUR CRITICAL OPERATIONS:

The following is a prioritized list of our critical operations, staff and procedures we need to recover from a disaster:

OperationStaff in ChargeAction Plan

______

______

______

______

______

□ Person In Charge of the Emergency:

______

SAMPLE EMERGENCY RESPONSE PROCEDURE

□ Public Information Person is:______

□ OUR EMERGENCY KITS ARE LOCATED:

______

□ OUR EMERGENCY KITS CONTAIN:

______

□ SUPPLIERS AND CONTRACTORS

Company Name:______

Street Address:______

City: ______State: ______Zip Code: ______

Phone: ______Fax: ______E-mail: ______

Contact Name: ______Account Number:______

Materials/Service Provided:______

If this company experiences a disaster, we will obtain supplies/materials from the following:

Company Name: ______

Street Address: ______

City: ______State: ______Zip Code: ______

Phone: ______Fax: ______E-mail: ______

Contact Name: ______Account Number: ______

Materials/Services Provided: ______

If this company experiences a disaster, we will obtain supplies/materials from the following:

Company Name: ______

Street Address: ______

City: ______State: ______Zip Code: ______

Phone: ______Fax: ______E-mail: ______

Contact Name: ______Account Number: ______

Materials/Services Provided: ______

SAMPLE EMERGENCY RESPONSE PROCEDURE

□ EVACUATION PLAN FOR______LOCATION

(Insert Address)

  • Unless otherwise informed the preferred evacuation path to the Assembly Area is: ______

If we must evacuate the site quickly:

______

______

Accountability of personnel will be performed in this manner:

______

Assembly Area: ______

Backup Assembly Area: ______

Assembly Area Manager & Alternate: ______

  1. Responsibilities Include:

______

______

______

In the event of a loss of power emergency, contact:

______

______

______

Backup generator and instructions are located :

______

______

______

SAMPLE EMERGENCY RESPONSE PROCEDURE

□ SHELTER-IN-PLACE PLAN FOR______LOCATION

(Insert Address)

  • We have talked to co-workers about which emergency supplies, if any, the company will provide in the shelter location and which supplies individuals might consider keeping in a portable kit personalized for individual needs.
  • We will practice shelter procedures ______times a year.

1. If we must take shelter quickly:

Storm Shelter Location: ______

2. “Seal the Room” Shelter Location: ______

3. Shelter Manager and Alternate: ______

  1. Responsibilities Include:

______

4. Shut Down Manager & Alternate: ______

  1. Responsibilities Include:

______

5. ______is responsible for issuing all clear.

SAMPLE EMERGENCY RESPONSE PROCEDURE

In the event of a disaster we will communicate with employees in the following manner (Telephone, Website, Radio Announcement):

______

The day after the disaster, employees should:

□ Stay Home □ Report to:______

□ CYBER SECURITY

If our computers are destroyed, we will use back-up computers at the following location: ______

□ RECORDS BACK-UP

______is responsible for backing up our critical records including payroll and accounting systems.

Back-up records including a copy of this plan, site maps, insurance policies, bank account records and computer back ups are stored onsite at: ______

Another set of back-up records is stored at the following off-site location:

______

If our accounting and payroll records are destroyed, we will provide for continuity in the following ways: ______

______

______

SAMPLE EMERGENCY RESPONSE PROCEDURE

“CONFIDENTIAL”

□ EMPLOYEE EMERGENCY CONTACT INFORMATION

The following is a list of our co-workers and their individual emergency contact information:

In case of Emergency

Employee Name: Home Tel # / Cell Phone # Contact Person / Tel #

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

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