Guide
Emergency Preparation Forms (DoD)
Talk with your administrator. Complete this form with information from your program.
| 学龄Program Information | |
|---|---|
| Name of Program | |
| Street Addresss | |
| City | |
| State | |
| Zip Code | |
| Telephone Number | |
| Alternate On-Installation Facility 1 (Program may operate in this facility if the main facility is not accessible) | |
| Name of Facility | |
| Street Addresss/Building Number | |
| City | |
| State | |
| Zip Code | |
| Telephone Number | |
| Directions to Facility | |
| Alternate Off-Installation Facility 2 (Program may operate in this facility if the alternate facility is not accessible) | |
| Name of Facility | |
| Street Addresss/Building Number | |
| City | |
| State | |
| Zip Code | |
| Telephone Number | |
| Directions to Facility | |
| Primary Point of Contact (Administrator) for my Facility | |
| Name | |
| Telephone Number | |
| Alternate Telephone Number | |
| Email Address | |
| Emergency Contacts | |
| Life Threatening Emergency | 911 |
| Non-Emergency Police | |
| Non-Emergency Fire | |
| Insurance Provider | |
| Emergency Essential Personnel | |
| Staff Name | |
| Staff Name | |
| Staff Name | |
| Staff Name | |
| Evacuation Plan | |
| Evacuation Manager and Alternate | |
| Person responsible for issuing all-clear | |
| Assembly site manager and alternate | |
| Assembly site location | |
| Person able to handle medical emergencies | |
| Location of evacuation exits | |
| Location Nearby Assembly Site | |
| Location of Distant Assembly Site | |
| Location of More Distant Assembly Site | |
| Shelter-In-Place Plan | |
| Person responsible for issuing all-clear | |
| Person able to handle medical emergencies | |
| Storm shelter location | |
| Person responsible for maintaining and refreshing emergency supplies | |
| Location where personal supplies are stored (if staff must remain in building for extended period of time) | |
| Location where children's supplies are stored for extended shelter-in-place events | |
| Materials included in shelter-in-place kit | |
| Evacuation Plan | |
| Evacuation Manager and Alternate | |
| Person responsible for issuing all-clear | |
| Assembly site manager and alternate | |
| Assembly site location | |
| Person able to handle medical emergencies | |
| Location of evacuation exits | |
| Location of Nearby Assembly Site | |
| Location of Distant Assembly Site | |
| Location of More Distant Assembly Site | |
| Lock-Down Plan | |
| Person responsible for issuing all-clear | |
| Person able to handle medical emergencies | |
| Lock-down shelter locations in classroom | |
| Lock-down shelter locations in common areas (playground, etc.) | |
| General Emergency Plan | |
| 急救箱的位置在教室 | |
| Communications | |
| How will emergency plans be communicated to me? | |
| How will emergency plans be communicated to families? | |
| How can I check in with my administrator following an emergency? | |
Adapted from Child Care Aware USA (2006) and Sample Emergency Plan available from the federal Emergency Management AgendyReady website.