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PEEPs fire safety template

PEEPs fire safety template

Create personalized evacuation plans with this template. Designed for individuals requiring assistance, it covers key details like support needs and assistive devices.

Use this template
or download pdf
PEEPs fire safety template

Create personalized evacuation plans with this template. Designed for individuals requiring assistance, it covers key details like support needs and assistive devices.

Use this template
or download pdf

About the PEEPs fire safety template

This PEEPs fire safety template is specifically designed to help businesses support team members who may require assistance during an evacuation. PEEPSs (Personal Emergency Evacuation Plans) cover those with mobility challenges, disabilities, and medical conditions that affect their ability to evacuate.

Use this template to streamline the process of assessing needs, assigning responsibilities, and communicating emergency procedures. You’ll have an organized way to document crucial details, from assistive devices to emergency contacts, so you and your team can act quickly when it matters most.

How to us the PEEPs fire safety template

Follow these steps to set up the checklist and guide your team effectively:

  1. Customize the template to your needs. Open the PEEPs fire safety template in Lumiform’s digital form builder. Edit sections like emergency contacts, required assistance, or equipment specifics to reflect your own safety requirements. You can also use Lumiform’s action management to assign responsibilities.
  2. Provide personal details. Once the template is ready, ask the relevant individuals to fill it out, starting with their name, location, and contact information. They should be specific about where they’ll likely be during an emergency, such as their floor and room number.
  3. Document emergency assistance needs. Next, they can outline disabilities or conditions that may affect their ability to evacuate independently. This includes the type of support they might require, such as physical assistance or alternative evacuation routes.
  4. Add emergency contact information. Provide the names and phone numbers of primary and secondary emergency contacts. These contacts will serve as additional support or coordination points during an emergency.
  5. Review and share the plan. Once the template is completed, share it with the building’s emergency coordinators and other relevant team members. Conduct practice drills to test the plan, refine it as needed, and ensure everyone involved understands their role.

Best practices for using the PEEPs fire safety template

Follow these tips to make the template a practical tool during emergencies.

Be detailed and specific with assistance needs. Clearly describe the type of help required, such as physical support or additional time to exit. Include specifics like whether assistance is needed to operate an elevator, navigate stairs, or handle sensory challenges. Detailed descriptions help responders act quickly and effectively in real scenarios.

Record all assistive devices used. List every device the individual relies on, from wheelchairs to hearing aids. Include storage locations, power requirements, or maintenance needs so nothing is overlooked during evacuation.

Practice with evacuation drills. Simulate emergencies to identify gaps or challenges in the plan. Pay attention to how well the assistance needs and device accommodations work in practice.

Download Lumiform’s PEEPs fire safety template today

Create thorough and reliable emergency plans tailored to your team’s unique needs with this template. Use it to document key information like assistive devices, contact details, and specific support requirements so everyone has a clear and actionable plan during critical moments. It’s also designed to make your workflow seamless—you can share it easily with your team and update it as needed to keep your emergency strategy sharp.

Related categories

  • Health and safety management templates
  • Risk management and compliance templates
  • Facility management templates
  • Public sector templates
  • Emergency preparedness templates
  • Fire safety templates
Preview of the template
Page 1
Personal Information
Full Name
Building/Floor/Room
Primary Contact Number
Secondary Contact Number
Emergency Assistance Needs
Do you have any disabilities or conditions that may require assistance during an emergency evacuation?
If yes, please describe the assistance you may require
Do you use any assistive devices (e.g., wheelchair, walker, cane)?
If yes, please describe the device(s) you use
Emergency Contacts
Primary Emergency Contact Name
Primary Emergency Contact Phone
Secondary Emergency Contact Name
Secondary Emergency Contact Phone
Evacuation Plan
Are you familiar with the emergency evacuation procedures for your building?
Have you identified the nearest emergency exits and assembly areas?
Do you require any special assistance to evacuate the building?
If yes, please describe the assistance you may require
Have you practiced your emergency evacuation plan?

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Frequently asked questions

Who is responsible for PEEPs?

The employer or building manager is usually responsible for PEEPs. They must assess the needs of individuals requiring assistance during an evacuation and collaborate with emergency coordinators and safety teams to develop the plan. The individual’s input is also essential to tailor the plan effectively.

What is the main purpose of a PEEPs fire safety plan?

A PEEPs fire safety plan ensures that individuals with specific needs, such as mobility or sensory impairments, have a clear and personalized strategy for evacuating safely during an emergency. It addresses unique requirements to minimize risks and streamline evacuation efforts.

How can I identify if someone needs a PEEPs plan?

To identify if someone needs a PEEPs, consider whether they face barriers during an emergency evacuation. These may include mobility challenges, reliance on assistive devices, sensory impairments, or medical conditions. You can conduct regular workplace assessments and discuss directly with team members to get clear on individual needs.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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