Unit VII SA
77foxtrot
UnitVII_Template.docx
Location:
Description:
Incident/Emergency Reporting:
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Emergency Contacts |
Address |
City |
State |
Zip |
Phone |
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EVACUATION ASSEMBLY AREAS
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Evacuation Assembly Areas (See Map for exact locations) |
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PROJECT CONTACTS
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Name |
Title |
Company |
Phone |
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Role |
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MEDICAL FACILITIES / CLINICS IDENTIFIED FOR THE PROJECT (Provide Maps)
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Facility Name |
Address |
City |
State |
Zip |
Phone |
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1
SITE-SPECIFIC CONDITIONS OR HAZARDS
Equipment on site
TYPE |
LOCATION |
RESPONSIBLE PARTY |
*example – tower crane |
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Fire Hazards
TYPE |
LOCATION |
RESPONSIBLE PARTY |
*example – compressed gas |
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Other Conditions or Hazards
TYPE |
LOCATION |
RESPONSIBLE PARTY |
*example – heat stress |
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EMERGENCY ACTIONS – Describe the steps necessary to implement the plan (How will this be accomplished?)
Emergency Communication / Alarms (Provide information on how workers are notified)
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Emergency Evacuation (Provide information on where to exit, how to exit, when to exit)
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Accountability and Headcount
Location |
Responsible Person |
Contact Information |
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Fire Extinguisher Locations
Location |
Designated to Use |
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First Aid Kit Locations
Location |
Designated to Administer First Aid |
Contact Information |
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3
TYPES OF POTENTIAL EMERGENCIES AND RESPONSES / ACTIONS
(Examples – Provide Response Actions for Each, add additional as appropriate)
Fire Hazards
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Falls from Height
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Structural Collapse
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Equipment Emergencies (Crane collapse, struck by, etc.)
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Natural Gas Leak or Explosion
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Chemical Releases
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First Aid and Medical Emergencies
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Weather events / Natural disasters (Example – lightning, tornadoes)
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Workplace Violence
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Other Emergencies and Reponses
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TRAINING REQUIREMENTS AND DRILLS
Address how you will conduct training on the EAP, where the information can be found, and any drill / practice measures you will have in place.
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MAPS
Provide maps as appropriate for:
Egress / Evacuation Points
Assembly Areas
Fire Extinguisher Locations
First Aid Stations
Medical Facilities
References
