Fire Safety and Evacuation Plan - Cover Sheet
Instructions: Fill out form. Items in red boxes are required.
FACILITY INFORMATION
Facility Name
Manager Name
Facility Address
Business Phone
E-mail
Owner Name
Owner Address
Owner Phone
BUILDING INFORMATION
Building Occupancy Classification (If known)
Total Building Square Footage (all levels)
# of Occupied Floors Above Grade
# of Occupied Floors Below Grade
CONTACT INFORMATION
Personnel Able to Provide Additional Information/Explanation of Plan
Name/Title
Phone #
E-mail
Name/Title
Phone #
E-mail
Emergency Contact for Key Personnel and Owners Agent
Name/Title
Phone
Phone 2/Pager
Name/Title
Phone
Phone2/Pager