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This template includes general questions, evacuation policies and procedures, reporting emergencies and alerting employees in an emergency, and employee training and drills. Assign an action with a priority level and due date to each checklist item marked "None or not sure, apply corrections immediately".
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Does the plan take into account all potential natural or man-made emergencies that could disrupt the workplace?
Does the plan take into account all potential internal sources of emergencies that could disrupt the workplace?
Does the plan consider the impact of these internal and external emergencies on the operation of the workplace and is the response tailored to the workplace?
Does the plan include a list of key employees with contact information, as well as contact information for local emergency responders, agencies and contractors?
Does the plan include the names, titles, departments and telephone numbers of people to contact for additional information or an explanation of duties and responsibilities under the plan?
Does the plan address how the rescue operations will be conducted?
Does the plan address how medical assistance will be provided?
Does the plan specify how or where personal information about employees can be obtained in an emergency?
Evacuation Guidelines and Procedures
Does the plan contain the conditions under which an evacuation would be necessary?
Does the plan provide for a clear chain of command and designate a person authorised to order an evacuation or to stop action?
Does the plan address the types of action expected from the different employees for the different types of potential emergencies?
Does the plan specify who, if anyone, will stay to shut down critical operations during an evacuation?
Does the plan include specific evacuation routes and exits, and are they located in the workplace where they are easily accessible to all employees?
Does the plan address procedures for assisting people during evacuations, especially people with disabilities or people who do not speak the local language?
Does the plan include one or more meeting areas (as needed for different types of emergencies) where employees gather and a method for counting all employees?
Does the plan address how visitors will be assisted in the evacuation and how this will be accounted for?
Reporting Emergencies and Alerting Employees
Does the plan include a preferred method for reporting fires and other emergencies?
Does the plan describe the method to be used to alert employees, including disabled workers, to evacuation or other measures?
Employee Training and Drill
Does the plan include details of how and when staff will be trained to understand the types of emergencies that may occur and their responsibilities and actions as outlined in the plan?
Does the plan address how and when the training will be provided?
Does the plan address whether and how often training should be provided?
Confirmation
General recommendations
Name
Signature
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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