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~ Plan to Stay in Business ~
All Hazards Preparedness & Emergency Response Plan
THIS PLAN IS TO BE REVIEWED AT LEAST ANNUALLY
Plan Created: _____________ Approval by: ___________________________
Plan Reviewed/Updated: _____________ Approval by: ___________________________
Plan Reviewed/Updated: _____________ Approval by: ___________________________
Plan Reviewed/Updated: _____________ Approval by: ___________________________
Plan Reviewed/Updated: _____________ Approval by: ___________________________
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the
U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
Authorized Signature
Authorized Signature
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Authorized Signature
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Plan to Stay in Business
Planning is an orderly, analytical, problem-solving process. It includes plan initiation,
analysis of objectives, development and comparison of ways to achieve the objectives,
and selection of the best solution.
Plans guide preparedness activities. They provide a common framework by establishing
the desired end state, and the tasks and capabilities required to accomplish it.
Emergency planning addresses all hazards. The causes of emergencies can vary greatly,
but many of the effects do not. This means planners can address emergency functions
common to all hazards in the basic plan instead of having unique plans for every type of
hazard.
Planning must involve all partners. The most realistic and complete plans are prepared
by a team of representatives of the government agencies, private sector and non-
governmental organizations (partners) that will execute the plan.
☑ DEVELOP an Emergency Plan for your facility,
☑ COMMUNICATE the Plan to your employees,
☑ TRAIN your employees to implement the Plan,
☑ PRACTICE your Plan regularly, and
☑ UPDATE your Plan with any significant changes to the
facility, or at least annually.
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Table of Contents
!
PURPOSE!AND!SCOPE .....................................................................................................................................................................4!
GETTING!STARTED!CHECKLIST ....................................................................................................................................................5!
DESIGNATE!A N!EMERGENCY!COORD INAT OR.............................................................................................................................6!
PRE PAREDNE SS...............................................................................................................................................................................7!
BUI LDIN G!EVACUATION!FLOOR!PLAN ................................................................................................................................... 8,!9!
EMERGENCY!EVACUATION!STEPS............................................................................................................................................. 10!
AREA(S)!OF !ASSEMBLY........................................................................................................................................................11,!12!
STAGING !AREAS!–!EMERG ENCY!SERVICES .............................................................................................................................. 13!
DUTIES!AND!RESPONSIBILITIES ................................................................................................................................................14!
DESIGNATED!AREA!MONITORS..........................................................................................................................................15,!16!
DESIGNATED!AREA(S)!OF!REFUGE...........................................................................................................................................17!
EVACUATION!PROCEDURES!FOR!PERSONS!WITH!DISABILITIES.......................................................................................... 18!
TRA INING!AND!FIRE/EVACUA TION!DRILLS ........................................................................................................................... 19!
IMMEDIATE,!CRITICAL !NOTIFICATIONS................................................................................................................................... 20!
FACILITY!EM ERGENCY!STAFF.................................................................................................................................................... 21!
IMPORTANT,!BUT!NOT!IMM EDIA TE!NOTIFICATIONS............................................................................................................. 22!
VENDOR!SER VICES!AND!SUPPLI ES!CONTACT!INFORMATION .............................................................................................. 23!
COMMUNITY!RES OURCES .............................................................................................................................................24,!25,!26!
FACILITY!EM ERGENCY!ORGANIZATION!CHART ..................................................................................................................... 27!
AREA(S)!OF !HIGH!RISK .......................................................................................................................................................28,!29!
SPECIAL! DUTIES!AND!SHUTDOWN!PROCEDURES .................................................................................................................. 30!
RECOVERY!INFO!
DOCUMENTING!EMERGENC Y!OUTCOMES ............................................................................................................... 31!
EMERGENCY!RECOVERY!SUPPORT!NEEDS ............................................................................................................. 32!
FORMS!
EMPLOYEE/OCCUPANT!ACCO UNTABILITY ............................................................................................................ 33!
COMPAN Y!TELEPHONE!TREE ................................................................................................................................... 34!
PLAN!REVIEW!SHEETS............................................................................................................................................... 35!
INCI DENT!COMMA ND!–!SAMPLE!MOU.................................................................................................................................... 36!
CREDENTIALING!KEY!EMPLOY EES!–!SAMPLE!MOU ............................................................................................................. 44!
!
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PURPOSE & SCOPE
Purpose
This emergency plan is to provide guidance to employees in the form of
comprehensive, yet simple and flexible procedures that can apply to a variety of
emergency incidents that may occur, including but not limited to:
• Weather-related emergency
• Fire and/or explosion
• Hazardous materials spill and/or chemical release
• Bomb Threat and/or Workplace violence
This written plan is designed to clearly provide the necessary information and guidance
to ensure any assigned occupant can safely implement an evacuation of the facility to a
safe location. Each employee is responsible for understanding and following this
emergency plan.
Scope
Under this Plan, employees will be informed of:
• The Plan’s purpose,
• Preferred means of reporting fires and other emergencies,
• Emergency escape procedures and route assignments,
• Procedures to be followed by employees who remain to control critical
operations before they evacuate,
• Procedures to account for all employees after emergency evacuation has
been completed,
• Rescue and medical duties for all employees who perform them, and,
• the alarm system (if equipped).
It is important to understand this plan must be maintained as current, therefore it must
remain as a “living document” or work-in-progress.
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GETTING STARTED CHECKLIST (Use these Benchmarks to Guide your Planning Process)
Designate an Emergency Coordinator and an Alternate Emergency Coordinator
for your facility.
Designate Safety Monitors and Alternate Safety Monitors for specific work areas
in the facility.
Obtain and Post Floor Plans with Evacuation Routes.
Establish Primary & Secondary Areas of Assembly at safe locations outside of
your building.
Review your operations to determine Critical Operations that may require
continuing attention or shutdown during an evacuation or other emergency.
Develop procedures to ensure that requisite actions are taken during an emergency.
Ensure that you have designated personnel to address these issues, provided them with
the procedure, and trained them in its use.
Train the Evacuation Coordinator and all Safety Monitors on their responsibilities
to implement the plan and assist in the safe and orderly evacuation of building
occupants. Ensure that you have a procedure in place for communication and
evacuation or safe refuge for disabled persons.
Customize the text and appendices of this Plan to your facility. Designate
responsibility for plan custody, storage, annual review and update. Develop employee
responsibility lists as indicated in the plan appendices. Develop a Training Plan Outline
for distribution and review by employees.
Conduct training in Plan requirements with all building occupants. Ensure
occupants are aware of evacuation procedures. Keep a copy of evacuation plan training
records using the training form in the Plan appendix.
Conduct periodic evacuation drills and critique performance.
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DESIGNATE AN EMERGENCY COORDINATOR
Emergencies and disasters are unpredictable, may occur at any moment and, usually
without warning. When an emergency happens, the safety of all employees will depend
on the level of planning and preparedness.
Emergency plans are an essential component of basic health and safety as well as
business continuity planning. Emergency plans outline how an organization will:
• Provide for the safety of staff and visitors, and
• Coordinate emergency response procedures
NAME:
TITLE:
….is
designated as the Emergency Coordinator for this facility and has overall
responsibility for the preparation and implementation of this Plan.
NAME:
TITLE:
….is
designated as the Alternate Emergency Coordinator for this facility.
The Emergency Coordinator will review and update the Plan as necessary. Copies of
the Plan will be maintained in the
.
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the
U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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PREPAREDNESS
The first step in preparedness is to assemble appropriate human and physical resources
to do the job. Be prepared to do the following:
• Recruit a core Emergency Preparedness Coordinator or, if staff is adequate,
a Committee that represents staff and other partners
• Collaborate with partners to develop and maintain the information for your
emergency plan
• Arrange related staff preparedness education and training
• Purchase department emergency supplies
• Support the designated emergency manager during an incident
• Be certain procedures are in-place for making critical notifications during
business hours and after-hours emergencies
• Establish “telephone trees” and “distribution” email lists to initiate rapid
emergency notifications
• If possible/feasible create a department “Emergency Hotline” so that
employees call into the department to hear recorded announcements and
instructions
• Help prepare post-disaster impact summaries and insurance claims
Emergency Preparedness Committees may consider dividing their members into an
Emergency Response Team and an Emergency Recovery Group to handle those
specialized activities.
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the
U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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BUILDING EVACUATION FLOOR PLAN
To prepare a Building Evacuation Floor Plan:
Obtain a floor plan of your building to use as a base plan.
Add to the floor plan:
o Primary and secondary routes of exit
Identify the two closest exits to the work area
Clearly mark these routes
o Designated Area(s) of Assembly – Primary and Secondary
This should be a safe location(s) outside of your building that is
away from building exits, entrances, parking, and loading areas
where all employees/visitors can be accounted for.
o Exit locations
o Fire alarm pull station locations
o Areas of Refuge for Disabled Occupants
These are areas within the building for use in assisting with the
evacuation of disabled occupants and visitors. These areas
should be located close to an exit or stairway, have windows and
a phone.
o Portable fire extinguisher locations
o Location of Automated External Defibrillators (AED)
Although AED’s are not considered to be part of the fire system,
they are considered a critical component in emergency
situations. A trained individual should be assigned the
responsibility of ensuring the AED is taken out of the building as
part of the evacuation procedure.
Copies of the Evacuation Floor Plans should be posted within the building at:
o Every Floor
o Lobbies
o Elevator lobbies
o Corridors and other locations where exits are not readily visible.
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BUILDING INFORMATION
SAMPLE FLOOR PLAN
<Remove this page and replace with Evacuation Map(s) for your facility>
DESIGNATED PRIMARY
AREA OF ASSEMBLY
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EMERGENCY EVACUATION STEPS
Step 1: If a fire or any type of emergency exists, evacuation must occur.
Individual who discovers fire must ensure Steps 2 and 3 occur before attempting to
fight an incipient fire using the PASS, (Pull, Aim, Squeeze, Sweep) method.
Step 2: Activate the fire alarm.
Designated Areas of Refuge
If an occupant is unable to evacuate from above and or below the grade level exit, they
must proceed to the closest and safest area of refuge. Inform 9-1-1 Center of their
location and that they are unable to leave the building.
Designated Areas of Refuge are to be established on each floor of the Building.
Step 3: Call 9-1-1.
When a confirmed fire exists, it is critical to inform 9-1-1 Center operator of the
following information: Provide building address and location of fire or other
emergency.
Step 4: Evacuate the building whenever the fire alarm sounds.
Close any doors, leave the building and relocate to a safe, designated area for
accountability.
Step 5: Reassemble at a safe location and verify accountability - Primary or
Secondary Area of Assembly.
All occupants must reassemble at the designated assembly area away from the building.
Directors proceed with taking attendance of employees to ensure everyone is accounted
for. If it is known that someone is still in the building, notify the emergency response
personnel with the information and their location within the facility.
The person responsible for designating primary and secondary assembly areas for
employees to gather in an emergency evacuation is:
.
Step 6: Do not re-enter until authorized by emergency personnel.
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AREA(S) OF ASSEMBLY (AREA = DIVISION, DEPARTMENT, FLOOR, REGION, OR SECTION OF THE FACILITY)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
PRIMARY AREA OF ASSEMBLY
The primary area of assembly for _______________________ is located:
SECONDARY AREA OF ASSEMBLY
The secondary area of assembly (use only if the Primary Area of Assembly cannot
be accessed) for _______________________ is located:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
PRIMARY AREA OF ASSEMBLY
The primary area of assembly for _______________________ is located:
SECONDARY AREA OF ASSEMBLY
The secondary area of assembly (use only if the Primary Area of Assembly cannot
be accessed) for _______________________ is located:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
PRIMARY AREA OF ASSEMBLY
The primary area of assembly for _______________________ is located:
SECONDARY AREA OF ASSEMBLY
The secondary area of assembly (use only if the Primary Area of Assembly cannot
be accessed) for _______________________ is located:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Area 1
Area 1
Area 2
Area 2
Area 3
Area 3
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PRIMARY AREA OF ASSEMBLY MAP
<Remove this page and replace with Area of Assembly Map(s) for your facility>
SECONDARY AREA OF ASSEMBLY MAP
<Remove this page and replace with Area of Assembly Map(s) for your facility>
SAMPLE “AREA OF ASSEMBLY” MAP
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STAGING AREAS - EMERGENCY SERVICES
In the event of an emergency, the areas immediately adjacent to the building will be
utilized as staging areas for emergency services (police and fire) equipment and
personnel.
These areas must be kept clear at all times once individuals have evacuated. Staging
areas provided for police and fire services can become dangerous to building occupants
during emergency situations.
Therefore, once building occupants have evacuated to safe areas, they are not to re-
enter the staging areas until an ‘all-clear’ message has been communicated by
emergency personnel.
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DUTIES AND RESPONSIBILITIES
Duties and responsibilities are determined and established by management. To ensure
all duties and responsibilities are achieved efficiently and effectively, the staff must
have appropriate delegation of specific tasks, e.g. monitor duties.
Utilize an organizational chain-of-command flow chart to assign tasks related to duties
and responsibilities. <see page 28>
In general, the goal is to maintain proficiency and certification of certain staff members
in CPR, First-Aid, and AED.
Special Duties
Designated individuals (area monitors) shall be established to ensure safe exiting
outside of the facility, directing occupants to the designated assembly point, and
preventing re-entry to the facility (prevention of re-entry to anyone except emergency
personnel ensures the protection of life and property—company and personal property).
SPECIAL CONSIDERATIONS
In addition to the normal emergency department personnel duties and responsibilities,
the following must also be considered and understood:
Personal limitations - As adults, each individual is solely responsible for themselves.
Any individual with physical limitations should advise others of any conditions or
limitations they may have and any arrangements or agreements for assistance with
other staff members must be preplanned and clearly understood. An “area of refuge”
(near a phone, furthest away from hazard areas within the facility, and close to or near a
window accessible by the fire department) must be preplanned within the facility for
those unable to exit the facility in normal fashion.
Guests (Unfamiliar with the facility) - The host must be prudent in assuring the
security and safety of their guests/visitors. Although as adults, we are responsible for
our own welfare—familiarizing ourselves with any facilities we visit (life safety
systems, exit locations, fire extinguishers, etc…), guests/visitors will rely on the host to
provide direction and assistance with evacuating the facility in an emergency. In the
case of large numbers of visitors, the host should always identify the exits as well as
assist in an actual emergency.
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DESIGNATED AREA MONITORS
1. On hearing the fire alarm, monitors should immediately render the room/cubicles
they are in as safe according to fire evacuation procedures.
2. After allowing time for the main body of people to evacuate, and only if safe to do
so, monitors should then check the rooms/cubicles in the immediate area. Working
through the rooms/cubicles systematically and closing doors if needed as each area
is cleared.
3. One monitor should be assigned to each individual within a department with
disabilities (buddy system) to assist that individual to a designated rescue area, stair
landing, or with evacuation procedures.
4. Monitors should take the closest First Aid Kit and AED when they evacuate.
5. When all rooms listed on the fire evacuation plan have been checked clear,
monitors must leave the building via the nearest available exit.
6. At either meeting place (Primary or Secondary assembly areas) monitors should
assist supervisors with a head count of the people that should be at the meeting site.
7. Communicate whether all staff has exited the building to senior management
person and to emergency personnel.
General Duties (Prior to an emergency, during normal business)
Monitors have an important role to play by observing the fire safety guidelines
provided in training and should be continually on the lookout for such things as
possible malfunctioning fire extinguishers, fire exits that are blocked, missing keys
for exits, and the fire evacuation diagrams. If any other possible hazards are
identified, they should be reported without delay.
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the
U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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DESIGNATED AREA MONITORS
(AREA = DIVISION, DEPARTMENT, FLOOR, REGION, OR SECTION OF THE FACILITY)
AREA:
MONITOR:
ALTERNATE:
AREA:
MONITOR:
ALTERNATE:
AREA:
MONITOR:
ALTERNATE:
AUTOMATED EXTERNAL DEFIBRILLATORS (AED)
Automated External Defibrillators (AED’S) may be installed within the building (see
floor plans section for location). It is recommended that selected staff attend training
certifying them in CPR, First-Aid, and AED. One individual from each floor of the
building shall be designated and responsible for removing the AED on their respective
floor and carrying it to the safe areas for possible emergency use.
Designated monitor responsible for the AED is:
AREA:
MONITOR:
ALTERNATE:
Designated monitor responsible for the AED is:
AREA:
MONITOR:
ALTERNATE:
Designated monitor responsible for the AED is:
AREA:
MONITOR:
ALTERNATE:
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DESIGNATED AREAS OF REFUGE
A “designated area of refuge” (near a phone, furthest away from hazard areas within
the facility, and close to or near a window accessible by the fire department) must be
preplanned within the facility for those unable to exit the facility in normal fashion,
(see building floor plan pages in section 2 for visual locations established as an “area of
refuge”) and/or if unable to exit floors higher than floor one, individuals with physical
limitations should be assisted to one of the “areas of refuge” or remaining on a stairwell
landing in one of the facilities exit stairs of their floor would be the safest place. Staff
members assisting individuals with limitations must inform emergency services
personnel responding to the building immediately of the need for rescue assistance for
disabled individuals and their location.
If unable to exit the floor, individuals should move to and remain on the nearest
stairway landing until emergency rescue personnel arrive.
SECOND FLOOR:
The Primary Area of Rescue Assistance is located:
The Secondary Area of Rescue Assistance is located:
THIRD FLOOR:
The Primary Area of Rescue Assistance is located:
The Secondary Area of Rescue Assistance is located:
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EVACUATION PROCEDURES FOR PEOPLE WITH DISABILITIES
IN ALL EMERGENCIES, AFTER AN EVACUATION HAS BEEN ORDERED:
People with disabilities should evacuate themselves from the building if possible.
If safe to do so, assist persons with disabilities (as indicated by that person), or
direct them to the nearest stairwell. Notify Emergency Personnel of the person’s
location.
DO NOT use elevators, unless authorized to do so by police or fire personnel.
If an individual with a disability cannot evacuate him/herself from the building,
he/she should go to the nearest stairwell if it is safe to do so, and tell someone who
is evacuating from the building that he/she is trapped there.
Check on people with special needs during an evacuation. A "buddy system",
where people with disabilities arrange for volunteers (co-workers/ neighbors) to
alert them and assist them in an emergency, is a good method.
Attempt a rescue evacuation ONLY if you have had rescue training or the person is
in immediate danger and cannot wait for professional assistance.
Always ASK someone with a disability how you can help BEFORE attempting any
rescue technique or giving assistance. Ask how he or she can best be assisted or
moved, and whether there are any special considerations or items that need to come
with the person.
RESPONSES TO EMERGENCIES:
MOBILITY IMPAIRMENT, (REFERS TO ANY INDIVIDUAL UNABLE TO EXIT THE
BUILDING DUE TO ANY CONDITION)
Bomb Threat, Earthquake, Fire, and Hazardous Materials Releases:
It may be necessary to help clear the exit route of debris (if safe to do so) so that the
person with a disability can move out or to a safer area.
If persons with mobility impairments cannot exit, they should move to a stairwell
or a Designated Area of Refuge (Shelter-in-Place).
Notify police or fire personnel immediately about any people remaining in the
building and their locations.
Police or fire personnel will decide whether people are safe where they are and will
evacuate them as necessary. The Fire Department may determine whether it is safe
to override the rule against using elevators.
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TRAINING AND FIRE/EVACUATION DRILLS
Training - Training is an integral part of any safety program, and it is responsible
management to ensure that all employees are trained on the Emergency Plan. It is the
responsibility of the employee to become familiar with the Emergency Plan, to know
evacuation routes, procedures, and the location of assembly areas.
A copy of the emergency evacuation plan will be provided to all employees for review.
Employees will receive plan updates at least annually thereafter, which will incorporate
a review of the emergency evacuation plan and it’s components to ensure everyone
understands it in its entirety.
Fire Drills – Fire/evacuation drills affecting all employees should be routinely
conducted, so that emergency procedures can be tested and to determine if changes are
needed to the evacuation plan. Such drills involve employees following evacuation
procedures and physically moving to the designated safe areas.
At the time of each fire drill, department phone tree procedures will be implemented,
tested and evaluated for effectiveness.
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the
U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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IMMEDIATE, CRITICAL NOTIFICATIONS
FIRE
Phone Number
Fire Emergency
911
MEDICAL EMERGENCY
Ambulance
911
POLICE
Police Emergency
911
Brown County Sheriff Emergency
911
OTHER
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FACILITY EMERGENCY STAFF – IMMEDIATE NOTIFICATIONS
Add contact information for those that will need to be contacted in case of emergency,
a minimum of four emergency staff members should be listed.
NAME:
OFFICE #:
MOBILE #:
HOME #:
EMAIL:
NAME:
OFFICE #:
MOBILE #:
HOME #:
EMAIL:
NAME:
OFFICE #:
MOBILE #:
HOME #:
EMAIL:
NAME:
OFFICE #:
MOBILE #:
HOME #:
EMAIL:
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IMPORTANT, BUT NOT IMMEDIATE NOTIFICATIONS
Name and Title
Office Phone
Home Phone
Cell Phone
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VENDOR SERVICES AND SUPPLIES CONTACT INFORMATION
Vendor Name
Phone Number
Account Number
Additional Information
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COMMUNITY RESOURCES
FIRE
PHONE
Fire Department Non-Emergency
Fire Prevention Office
MEDICAL
In-House Medical
Local Clinic
Ambulance Service Non-Emergency
POLICE
Local Police Non-Emergency
Brown County Sheriff Non-Emergency
920-448-4200
HOSPITALS
Bellin Hospital
920-433-3500
Aurora BayCare Hospital
920-288-3250
St. Mary’s Hospital
920-498-4200
St. Vincent Hospital
920-433-0111
PLANNING RESOURCES
Red Cross
920-746-2167
Chamber of Commerce
920-437-8704
Brown County Emergency Management
920-391-7430
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Wisconsin Division of Emergency Management
800-943-0003
U.S. Small Business Administration
800-827-5722
FEMA – Region V
312-408-5500
OSHA – Region V
312-886-6293
EPA – Region 5
800-621-8431
UTILITY COMPANIES
Wisconsin Public Service
800-450-7299
Brown County Public Works
920-676-5270
GB Metropolitan Sewerage
920-432-4893
Local Water Utility
LOCAL TELEVISION STATIONS
WBAY - 2
920-432-3331
WLUK - 11
920-4948711
WFRV - 5
920-437-5555
WGBA - 26
920-494-2626
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LOCAL RADIO STATIONS
WIXX
920-455-1011
WGEE
920-455-1360
WNFL
920-455-1440
WDUZ
920-468-4100
OTHER RESOURCES
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FACILITY EMERGENCY ORGANIZATION CHART
*AREA = DIVISION, DEPARTMENT, FLOOR, REGION, OR SECTION OF THE FACILITY)
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by
the U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
Facility Emergency Coordinator
Alternate Emergency Coordinator
*Area
AED Monitor
*Area
*Area
Alternate
Area Monitor
Area Monitor
Area Monitor
Alternate
AED Monitor
Alternate
Alternate
AED Monitor
Alternate
Alternate
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AREAS OF HIGH RISK
This is to identify two types of high risks in your department and then determine if there are ways
to minimize the risks. The two types of risks are:
• Risks of department’s business/assets (for Human Resources it might be legal personnel
records, payroll etc... To minimize the risks make sure redundant records are secured in
two different buildings or have all records in fireproof files).
• Risks of department’s operation that may cause unnecessary hazardous conditions or
exposure to occupants (flammable substances, toxic materials, nuclear reactor, commercial
power equipment, and other items requiring special shutdown procedures to prevent
unsafe conditions/exposures).
Contact Brown County Emergency Management to identify what (if any) nearby facilities may
have the potential to affect your employees (exposure) as the result of a chemical emergency.
AREAS OF HIGH RISK (EXPOSURE-TYPE RISKS ONLY)
<Insert a Map or Maps of Areas of High Risk for your facility >
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AREAS OF HIGH RISK
NFPA HazMat
Health Hazards
Flammables
Instability
Special Hazards
Special shutdown procedures
Room No.
Department
Space Description of High Risk Area
• Operations or areas of the building which have
the potential/capability of creating hazardous
conditions/exposures to occupants (i.e.,
laboratories with hazardous materials, radiation
or laser labs, large commercial type mechanical
systems--large motors, high voltage equipment
& transformers, etc…).OR,
• Things that are vital business operations that if
lost, stolen, or damaged are high risk to the
business of your operation (i.e., ongoing
contracts, documents, or equipment pertinent to
sustain your business operations, etc…).
#
#
#
Letter
Y/N
4R
IT
200 lbs. Sulfuric Acid in computer battery-backup system
3
0
2
W
Y
EXAMPLE
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SPECIAL DUTIES AND SHUTDOWN PROCEDURES
• Create easy to carry container of important items to take with during
evacuation. Items should include, but are not limited to:
Copy of evacuation plan
Important keys
First aid kit –(Need Site Locations)
Cell phone
Laptop computers if possible
• Close any and all doors
• Equipment/operation shut downs (computers, equipment, processes, items
generating heat or open flames, etc…)
• Facilities shutdown (utilities, special building equipment such as air handlers,
exhaust fans and elevators, etc…)
< List equipment that must be shut down >
Equipment:
Location of Shut-off :
Person responsible for shutdown:
Equipment:
Location of Shut-off :
Person responsible for shutdown:
Equipment:
Location of Shut-off :
Person responsible for shutdown:
Equipment:
Location of Shut-off :
Person responsible for shutdown:
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RECOVERY INFORMATION
DOCUMENTING EMERGENCY OUTCOMES
Once the safety and status of your staff has been assured, and emergency
conditions have abated, assemble an Emergency Recovery Team to begin the
restoration of the company’s programs.
Ensure that all computer work is backed up
It will be important to begin a timely and comprehensive assessment of the
emergency’s physical and operational effects. Plan ahead for how you will collect
this important impact information.
Upper management will need ongoing status reports from your unit during the
emergency to estimate when your program can be fully operational and to
identify special facility, equipment, and personnel issues or resources that will
speed business resumption
Management may need detailed facilities data for the area to estimate
temporary space reallocation needs and strategies
Most insurance and FEMA assistance claims will require extensive
documentation of damaged facilities, lost equipment and resources, and special
personnel expenses. Workers’ Compensation claims may arise if there are
injuries in your department.
All of your documentation on emergency impacts should be coordinated with
upper management. The following form provides a format for summarizing this
crucial information.
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by
the U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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RECOVERY INFORMATION
Emergency Recovery Support Needs/Logistical Issues
List immediate facility and space needs
•
•
•
•
List urgent equipment requirements to become operational
•
•
•
•
List critical personnel and resources issues
•
•
•
•
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by
the U.S. Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant,
administered by Wisconsin Emergency Management
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FORMS -- EMPLOYEE/OCCUPANT ACCOUNTABILITY
**MAKE COPIES AS NEEDED**
**Keep a copy of this list in an easily accessible location, such as the front of your Emergency Plan Binder. In an
emergency, take the list with you when you leave the building. Note persons in your area as they are accounted for, and
notify the Emergency Coordinator, or Fire Department if you know of someone in your area who could not get out of the
building.
Table of Area Occupants for
~~ Everyone in the area must be listed ~~
Name - Title
Accounted?
Dept.
Room No.
Phone No.
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FORMS -- COMPANY PHONE TREE -- (TO INCLUDE WORK, HOME, CELL AND PAGER #’S)
**MAKE COPIES AS NEEDED**
~~ Confidential Information ~~
<Copy and insert one page for each area/division>
Each Manager is responsible for contacting each person in their division to inform them of the
emergency. To complete the telephone tree each manager must then call the head of the
Department to inform them that everyone has been notified.
*This is confidential information, everyone within the department needs to be on the telephone tree - it is
important that this be updated when someone leaves, enters or changes a number*
Name and Title
Office Phone
Home Phone
Cell Phone
MGR.-
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FORMS -- PLAN REVIEW SHEET
**MAKE COPIES AS NEEDED**
All employees must review the emergency plan annually or whenever there are
plan or facility design/occupancy use changes (each individual must print, sign,
and date the review sheet once their review is accomplished). In addition, on an
annual basis, all staff must maintain proficiency in the use of portable fire
extinguishers.
EMERGENCY EVACUATION PLAN REVIEW SHEET
Use this form to indicate each employee has reviewed the plan Copy at least annually.
Please Print
Name
Signature
Date
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INCIDENT COMMAND – SAMPLE MOU
[Company Logo] [Responding Agency Logo]
MEMORANDUM OF UNDERSTANDING
Between
And
Responding Agency
Issue Date
Last Update
Review Date
Text Name
Incident Command
I. Purpose
The purpose of this MOU policy is to provide a clear explanation of the Incident
Command System (ICS). The Incident Command System:
Is a standardized management tool for meeting the demands of small or large
emergency or nonemergency situations.
Represents "best practices" and has become the standard for emergency
management across the country.
May be used for planned events, natural disasters, and acts of terrorism.
Is a key feature of the National Incident Management System (NIMS).
The ICS is a management system designed to enable effective and efficient domestic
incident management by integrating a combination of facilities, equipment, personnel,
procedures, and communications operating within a common organizational structure,
designed to enable effective and efficient domestic incident management. A basic premise
of ICS is that it is widely applicable. It is used to organize both near-term and long-term
field-level operations for a broad spectrum of emergencies, from small to complex incidents,
both natural and manmade. ICS is used by all levels of government—Federal, State, local,
and tribal—as well as by many private-sector and nongovernmental organizations. ICS is
also applicable across disciplines. It is normally structured to facilitate activities in five
major functional areas: command, operations, planning, logistics, and finance and
administration.
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II. Policy
This policy establishes the Incident Command System (ICS) for management of
emergencies to which the signed parties may become engaged. This policy is meant to
enhance collaboration and cooperation for planning and response between the public and
private agencies listed, each recognizing that the other has a substantial stake in successful
outcomes.
III. Terms and Definitions
The essential ICS features are listed below:
Standardization:
Common Terminology: Using common terminology helps to define organizational
functions, incident facilities, resource descriptions, and position titles.
Command:
Establishment and Transfer of Command: The command function must be
clearly established from the beginning of an incident. When command is
transferred, the process must include a briefing that captures all essential information
for continuing safe and effective operations.
Chain of Command and Unity of Command: Chain of command refers to the
orderly line of authority within the ranks of the incident management organization.
Unity of command means that every individual has a designated supervisor to whom
he or she reports at the scene of the incident. These principles clarify reporting
relationships and eliminate the confusion caused by multiple, conflicting directives.
Incident managers at all levels must be able to control the actions of all personnel
under their supervision.
Unified Command: In incidents involving multiple jurisdictions, a single
jurisdiction with multiagency involvement, or multiple jurisdictions with
multiagency involvement, Unified Command allows agencies with different legal,
geographic, and functional authorities and responsibilities to work together
effectively without affecting individual agency authority, responsibility, or
accountability.
Planning/Organizational Structure:
Management by Objectives: Includes establishing overarching objectives;
developing strategies based on incident objectives; developing and issuing
assignments, plans, procedures, and protocols; establishing specific, measurable
objectives for various incident management functional activities and directing efforts
to attain them, in support of defined strategies; and documenting results to measure
performance and facilitate corrective action.
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Modular Organization: The Incident Command organizational structure develops
in a modular fashion that is based on the size and complexity of the incident, as well
as the specifics of the hazard environment created by the incident.
Incident Action Planning: Incident Action Plans (IAPs) provide a coherent means
of communicating the overall incident objectives in the context of both operational
and support activities.
Manageable Span of Control: Span of control is key to effective and efficient
incident management. Within ICS, the span of control of any individual with
incident management supervisory responsibility should range from three to seven
subordinates.
Facilities and Resources:
Incident Locations and Facilities: Various types of operational support facilities
are established in the vicinity of an incident to accomplish a variety of purposes.
Typical designated facilities include Incident Command Posts, Bases, Camps,
Staging Areas, Mass Casualty Triage Areas, and others as required.
Comprehensive Resource Management: Maintaining an accurate and up-to-date
picture of resource utilization is a critical component of incident management.
Resources are defined as personnel, teams, equipment, supplies, and facilities
available or potentially available for assignment or allocation in support of incident
management and emergency response activities.
Communications/Information Management:
Integrated Communications: Incident communications are facilitated through the
development and use of a common communications plan and interoperable
communications processes and architectures.
Information and Intelligence Management: The incident management
organization must establish a process for gathering, analyzing, sharing, and
managing incident-related information and intelligence.
Professionalism:
Accountability: Effective accountability at all jurisdictional levels and within
individual functional areas during incident operations is essential. To that end, the
following principles must be adhered to:
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Check-In: All responders, regardless of agency affiliation, must report in to
receive an assignment in accordance with the procedures established by the Incident
Commander.
Incident Action Plan: Response operations must be directed and coordinated as
outlined in the IAP.
Unity of Command: Each individual involved in incident operations will be
assigned to only one supervisor.
Personal Responsibility: All responders are expected to use good judgment and be
accountable for their actions.
Span of Control: Supervisors must be able to adequately supervise and control
their subordinates, as well as communicate with and manage all resources under
their supervision.
Resource Tracking: Supervisors must record and report resource status changes as
they occur.
Dispatch/Deployment:
Dispatch/Deployment: Personnel and equipment should respond only when
requested or when dispatched by an appropriate authority.
IV. Modular Organization
Standardization of the ICS organizational chart and associated terms does not limit
the flexibility of the system. (See the chart on the next page.)
A key principle of ICS is its flexibility. The ICS organization may be expanded
easily from a very small size for routine operations to a larger organization capable
of handling catastrophic events.
Flexibility does not mean that the ICS feature of common terminology is
superseded. Note that flexibility is allowed within the standard ICS
organizational structure and position titles.
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Organizational chart showing that Command develops the overall incident objectives and strategy,
approves resource orders and demobilization, and approves the IAP by signature.
Operations assists with developing strategy, and identifies, assigns, and supervises the resources needed to
accomplish the incident objectives. Planning provides status reports, manages the planning process, and
produces the IAP. Logistics orders resources and develops the Transportation, Communications, and
Medical Plans. Finance/Administration develops cost analyses, ensures that the IAP is within the financial
limits established by the Incident Commander, develops contracts, and pays for the resources.
The Incident Commander will appoint a Liaison Officer to serve as the communications link between
emergency responders and facility/company stakeholders.
Command: Develops the
overall incident objectives
and strategy, approves
resource orders and
demobilization, and approves
the IAP by signature.
Finance/Admin:
Develops cost analyses,
ensures that the IAP is
within the financial limits
established by the IC,
develops contracts, and
pays for the resources.
INCIDENT COMMANDER
OPERATIONS
SECTION
PLANNING
SECTION
LOGISTICS
SECTION
FINANCE/ADMIN
SECTION
Logistics: Orders
resources and develops
the Transportation,
Communications, and
Medical Plans.
Planning: Provides
status reports, manages
the planning process,
and produces the IAP.
Operations: Assists
with developing strategy,
and identifies, assigns,
and supervises the
resources needed to
accomplish the incident
objectives.
LIAISON OFFICER
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V. Unified Command
The Unified Command organization consists of the Incident Commanders from the various
jurisdictions or agencies operating together to form a single command structure.
Overview
Unified Command is an important element in multijurisdictional or multiagency domestic incident
management. It provides guidelines to enable agencies with different legal, geographic, and
functional responsibilities to coordinate, plan, and interact effectively.
As a team effort, Unified Command overcomes much of the inefficiency and duplication of effort
that can occur when agencies from different functional and geographic jurisdictions, or agencies at
different levels of government, operate without a common system or organizational framework.
All agencies with jurisdictional authority or functional responsibility for any or all aspects of an
incident participate in the Unified Command structure and contribute to the following process and
responsibilities:
Determining overall incident strategies.
Selecting objectives.
Ensuring that joint planning for tactical activities is accomplished in accordance with
approved incident objectives.
Ensuring the integration of tactical operations.
Approving, committing, and making optimal use of all assigned resources.
The exact composition of the Unified Command structure will depend on the location(s) of the
incident (i.e., which geographical administrative jurisdictions are involved) and the type of
incident (i.e., which functional agencies of the involved jurisdiction(s) are required). In the
case of some multijurisdictional incidents, the designation of a single Incident Commander
may be considered to promote greater unity of effort and efficiency.
Authority
Authority and responsibility for an Incident Commander to manage an incident or event comes in
the form of a delegation of authority from the agency executive or administrator of the jurisdiction
of occurrence or inherent in existing agency policies and procedures. When an incident/event
spans multiple jurisdictions this responsibility belongs to the various jurisdictional and agency
executives or administrators who set policy and are accountable to their jurisdictions or agencies.
They must appropriately delegate to the Unified Commanders the authority to manage the incident.
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Given this authority, the Unified Commanders will then collectively develop one comprehensive set
of incident objectives and use them to develop strategies.
Advantages of Using Unified Command
The advantages of using Unified Command include:
A single set of objectives is developed for the entire incident.
A collective approach is used to develop strategies to achieve incident objectives.
Information flow and coordination is improved between all jurisdictions and agencies
involved in the incident.
All agencies with responsibility for the incident have an understanding of joint priorities and
restrictions.
No agency’s legal authorities will be compromised or neglected.
The combined efforts of all agencies are optimized as they perform their respective
assignments under a single Incident Action Plan.
VI. Joint Information Center (JIC):
The joint information center provides an organized, integrated, and coordinated mechanism to
ensure the delivery of understandable, timely, accurate, and consistent information to the public
in a crisis. It includes plans protocols, and structures used to provide information to the public
during incident operations, and encompasses all public information operations related to the
incident, including all federal, state, local, tribal, and private organization PIO’s or Public
Relations staff, and JICs established to support an incident. Key elements include the
following:
interagency coordination and integration:
developing and delivering coordinated messages;
support for decision-makers; and
flexibility and adaptability
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VII. Demobilization
Demobilization planning helps to:
Eliminate waste in resources.
Eliminate potential fiscal and legal impacts.
Ensure a controlled, safe, efficient, and cost-effective release process.
Demobilization policies and procedures depend on size of incident and may involve:
Fiscal/legal policies and procedures.
Work rules.
Special license requirements.
Other requirements.
For the Company;
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Approved: _____________________________________ Date: __________________
Title: ______________________________________
For the Responding Agency;
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the U.S.
Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant, administered by
Wisconsin Emergency Management
Authorized Signature
Authorized Signature
Authorized Signature
Authorized Signature
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CREDENTIALING OF KEY PERSONNEL – SAMPLE MOU
[Company Logo] [Responding Agency Logo]
MEMORANDUM OF UNDERSTANDING
Between
And
Responding Agency
______
Issue Date
Last Update
Review Date
MOU
Credentialing
I. Purpose
The purpose of this Memorandum of Understanding (MOU) is to establish a working arrangement
between
and the Responding Agency regarding the identification of
associates who, due to the nature of their job responsibilities,
would be authorized to gain access to any of the Company’s facilities following a disaster event that
resulted in the building being evacuated.
II. Background
The objective of this MOU is to identify to the Responding Agency key individuals within the
organization who have the authority to identify associates
from various recovery teams that should be granted access to the disaster site to help in investigating
and assessing the full impact of the disaster event. These individuals who are identified should then
be credentialed by the Incident Commander and allowed to continue their efforts in support of the
business recovery.
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III. Working Agreement
has identified
[# of people] with the assigned
responsibility of ensuring recoverability of our business. Each of these individuals are to be given
the authority to identify other associates who may need access to the disaster site to do a formal
assessment of the impact to our business and our recovery efforts. Each of these individuals will,
when communicating to the Incident Commander, identify themselves as
associates working on our overall recovery and will provide to the Incident
Commander the following identification:
• A company-issued badge with;
• Their picture on the front of the badge.
• The company logo on the front of the badge.
• Their name printed on the front of the badge.
• A verification contact number to verify identity, if deemed necessary.
After properly identifying themselves as explained above, any one of these individuals may then
identify additional associates who will need to be properly credentialed to enter the site. These
credentials are to be provided by the Responding Agency and are to be effective only for the duration
of the current disaster event. Once the event has been declared closed, the credentials given to these
associates are to be deactivated.
The parties may from time to time amend this MOU in writing, and such amendments, when
executed by both parties, shall then become a part of this MOU. This MOU is effective upon
signature by the designated
and Responding Agency
representatives.
This MOU remains effective until either party provides written notice of its intention to end
adherence to the terms of the MOU.
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For the Company;
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Approved: _____________________________________ Date: __________________
Title: ______________________________________
For the Responding Agency;
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Approved: _____________________________________ Date: __________________
Title: ______________________________________
Template prepared by the Brown County Local Emergency Planning Committee (LEPC) with funding assistance by the U.S.
Department of Transportation, Hazardous Materials Emergency Preparedness (HMEP) Planning Sub-Grant, administered by
Wisconsin Emergency Management
Authorized Signature
Authorized Signature
Authorized Signature
Authorized Signature
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