Fillable Editable Department Emergency Plan Template (Santa Clara University)

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Editable Department Emergency Plan Template (Santa Clara University)

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1
Department Emergency
Preparedness Plan Template
August, 2012
2
DEPARTMENT EMERGENCY PREPAREDNESS PLAN INTRODUCTION
The safety of our students, faculty, and staff is a priority of Santa Clara University. The
purpose of this Department Emergency Preparedness Plan Template is to provide each
Department with the means to document important emergency response information
before an emergency occurs. Preparing before an emergency happens can ensure an
effective and efficient means to protect our SCU community during times of emergency.
While no plan can completely prevent harm and damage, reasonable plans carried out
by knowledgeable and well trained personnel can and will minimize losses.
IN A MAJOR EMERGENCY, IT IS EXPECTED THAT ALL THOSE WHO DO NOT HAVE A
DEFINED EMERGENCY RESPONSE ROLE AND ARE ABLE TO LEAVE CAMPUS, WILL GO
HOME. Before leaving the campus, faculty and staff will be expected to report to their
respective departments before leaving the campus (resident students report to their
Resident Halls and non-resident students report to Leavey Center to sign out). This
provides your department with a record of who has left and who is still on campus for
emergency contact purposes. If unable to leave campus, students, faculty and staff will
report to Leavey Center to register for shelter.
Those who have had HEAT/CERT, First Aid, or other training that would be beneficial in
an emergency are encouraged to volunteer to support the campus emergency response
efforts. Volunteers may assist in support duties such as care and shelter services,
messaging, traffic direction and crowd control. Those wishing to volunteer will report to
the Benson Center for assignment.
This Template is intended to provide Department-specific information and be a
supplement to the SCU Emergency Operations Plan and the SCU Faculty and Staff
Emergency Procedure Handbook.
Emergency Preparedness Questions? Contact Sean Collins at 408-554-5078 or
spcollins@scu.edu
3
DEPARTMENT INFORMATION
This Emergency Preparedness Plan is written for:
Complete Department Information
Department
Building(s) #
Person completing this
template
Preparer’s Office
Phone
Preparer’s Email
Date
Completed/Updated
(this Emergency
Preparedness Plan
should be reviewed
annually)
Approved by
Title
KEY DEPARTMENT EMERGENCY STAFF
An emergency or disaster can occur at any time with little or no warning. Disasters may
affect widespread areas; therefore, city, county, and federal emergency assistance may
not be available for as long as 72 hours. Organizational preparedness and training is
essential to effective emergency operations. The chart on the next page documents
what emergency support and expertise is available within the Department.
4
KEY DEPARTMENT EMERGENCY STAFF
Title
Name
Office Phone
Cell Phone
Email
Department Chair
Alternate (if
Department Chair
unavailable)
Department
Roster Duty
(Person responsible
for indicating on
roster the
Department
personnel leaving
campus)
Alternate for
Roster Duty
Building
Evacuation Lead(s)
for Department
Building(s)
Department
HEAT/CERT-
trained Personnel
Department
CPR/AED-trained
Personnel
Assigned Buddies*
*Assign Buddies to assist disabled staff, patients, and/or visitors during an emergency
evacuation.
EVACUATION PLANNING AND INDIVIDUALS REQUIRING SPECIAL ASSISTANCE IN AN
EVACUATION
State law requires occupants to evacuate to a safe location when the fire alarm sounds,
or when ordered to do so by emergency response personnel. Your employees should
know their Emergency Assembly Point and two evacuation routes from their primary
work location and other locations where they work or frequent.
• Develop a personal evacuation plan for any person in the Department who might
require special assistance during an evacuation (see next page for template).
5
SPECIAL ASSISTANCE EVACUATION PLAN
There are no special needs individuals for this Department
OR
The following individuals have been identified and will require assistance during an
evacuation:
Name of Person
Needing Special
Assistance
Location
Office Phone
Assigned Buddy
I have notified the Building Evacuation Lead of the name/primary work location
of special needs individuals.
DEPARTMENT EMERGENCY ROSTER
In a major emergency, it is expected that all those who do not have a defined
emergency response role and are able to leave campus, will go home. Before leaving
the campus, faculty and staff will be expected to report to their departments when they
leave the campus (resident students report to their Resident Halls and non-resident
students report to Leavey Center to sign out). By reporting when leaving campus, it
provides SCU has a record of who has left and who is still on campus for emergency
contact purposes. If unable to leave campus, students, faculty and staff are to report to
Leavey Center to register for shelter.
Those who have had HEAT/CERT, First Aid, CPR/AED or other training that would be
beneficial in an emergency are encouraged to volunteer to support the campus
emergency response efforts. Volunteers may support duties such as messaging, traffic
and crowd control, care and shelter services. Those wishing to volunteer should report
to the Benson Center for assignment.
6
DEPARTMENT EMERGENCY ROSTER
Department list of faculty and staff to enable reporting on who has checked in and left
campus. Complete Columns 1 and 2 prior to an evacuation and Columns 3 and 4 after an
evacuation occurs and faculty and staff are directed to leave the campus (unless they
have an emergency role).
Faculty/Staff Name
Full or Part Time
(indicate F or P)
Registered to
leave Campus
(check column when
faculty or staff
calls/checks in)
Contact
Telephone
Number after
leaving Campus
(area code-number)
7
DEPARTMENT ESSENTIAL FUNCTIONS and SPECIAL NEEDS
Identify Department critical operations and resources and identify mitigation measures
that will protect the operations and/or resources in an emergency where there is a loss
of power or other impacts that could result in damage:
Operation /
Equipment
Location
Mitigation
Measures
for
Emergency
Situations
Contact Owner
Name
Contact
Number in an
Emergency
Laboratory
Freezers
Laboratory
Animals
Specialized
Equipment
Confidential
Records
Critical Research
Other
SCU BUILDING EMERGENCY STATUS REPORT
Following a major emergency with significant operational impact to the campus, your
Building Evacuation Lead will use the form in Attachment 1 to provide status reports of
damage and injuries, and to request assistance from the SCU Emergency Operations
Center (Facilities Building).
• Building Evacuation Leads will report status by telephone if available (call 408-
554-4742 or extension 4742) otherwise by designated runner.
8
DEPARTMENT EMERGENCY PREPAREDNESS PLAN IMPLEMENTATION CHECKLIST
Here is a checklist to help you to determine if your Department Emergency Preparedness
Plan is complete:
Check if
completed
Action
Completed DEPARTMENT INFORMATION
Completed KEY DEPARTMENT EMERGENCY STAFF chart
Assigned Buddies are designated to assist disabled staff, patients, and/or
visitors during an emergency evacuation
Completed INDIVIDUALS REQUIRING SPECIAL ASSISTANCE IN AN
EVACUATION chart (if applicable)
Developed a personal evacuation plan for any person in the Department
who might require special assistance during an evacuation and notified the
Building Evacuation Lead
Completed Columns 1 and 2 of the SCU DEPARTMENT EMERGENCY
ROSTER
Completed DEPARTMENT ESSENTIAL FUNCTIONS and SPECIAL NEEDS
chart
Ensure Building Evacuation Lead has copy of SCU BUILDING EMERGENCY
STATUS REPORT
Comments:
9
ATTACHMENT 1
SCU BUILDING EMERGENCY STATUS REPORT
Following a major emergency with significant operational impact to the campus, Building
Evacuation Lead use this form to provide a status report of damage and injuries, and to request
assistance from the SCU Emergency Operations Center (Facilities Building).
Report status by telephone if available (call 408-554-4742 or extension 4742) otherwise by
designated runner.
Building#: __________________________________________________
Date:________
Building Evacuation Contact Name:____________________
Emergency Phone #_____________
Check if no major problem at this time otherwise complete the tables below
Problem/Urgent Need
Exact Location
Details
Serious Injuries
Fire
Explosion
Building collapse
People trapped
Natural gas leak
Hazardous material spill
Other
Services Functioning:
Service
Yes
No
Telephones
Emergency Lighting
Electrical
Water
Gas
Elevators
Emergency Generators
Other
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Completed 1 February 2021

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