Fire Safety and Evacuation Plan - Written Plan
FIRE/EMERGENCY REPORTING AND OCCUPANT NOTIFICATION
INSTRUCTIONS: Complete form by providing required information. If a particular item does not apply then
indicate such in the response area. Items marked with red boxes are required. Use additional sheets if
necessary.
Describe the preferred and any alternative means of reporting fires and other emergencies to the fire
department.
Describe the preferred and any alternative means of notifying occupants of a fire or emergency.
Describe the emergency voice/alarm communication systems alert tone and pre-programmed voice
messages, where provided.
EVACUATION AND ACCOUNTABILITY
Describe egress or escape routes and whether evacuation of the building is to be complete or, where
approved, by selected floors or areas only.
Describe the life safety strategy and procedures for notifying, relocating or evacuating occupants,
including occupants who need assistance.
Describe the procedures for accounting for employees and occupants after evacuation has been
completed.
EMERGENCY RESPONSE AND CROWD MANAGEMENT
Describe procedures for employees who must remain to operate critical equipment before evacuating.
Describe procedures for assisted rescue for persons unable to use the general means of egress unassisted.
List the identification and assignment of personnel responsible for rescue or emergency medical aid.
Describe any special staff actions including fire protection procedures necessary for residents and shall be
amended or revised upon admission of any resident with special needs.
OCCUPANCY HAZZARDS
List all major fire hazards associated with the normal use and occupancy of the premises, including
maintenance and housekeeping procedures.
List the identification and assignment of personnel responsible for maintenance, housekeeping and
controlling fuel hazard sources.
List the identification and assignment of personnel responsible for maintenance of systems and equipment
installed to prevent or control fires.