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DIRECTIONS:

Completing this template:

Open this document in Adobe Reader or Adobe Pro. As you fill in the

blank fields, you can hover your mouse over the field and tips for completing

the section will pop-up.

Some sections are not applicable to all facilities (i.e. when your facility

does not occupy the Emergency Planning Zone of Ginna Nuclear Plant). Do

not include these sections which may not apply to your facility. You can

remove pages if have the Adobe Pro Software. If you only have Adobe

Reader, you will not have the capability to remove the sections. Type "Not

Applicable" on the non-applicable sections. When you print the Emergency

and Safety Plan out, removing the non-applicable pages will disrupt the

numerical order of the page numbers and it may cause confusion to

individuals while reading the plan.

Many facilities may have longer contact lists for the children than that

provided in this document. Inserting a complete contact list into the plan

may be more appropriate for your facility.

The page of resources (section 15) can provide more information or

tips and considerations if desired.

This template provides your child daycare facility a tool to prepare for

the most probable emergency events. It is important to develop and

maintain an Emergency and Safety Plan such as this document. Being

prepared for an emergency situation ensures that the appropriate response is

taken during the event, which will minimize the risk to human life and aid

in a faster recovery from the event.

EMERGENCY AND

SAFETY PLAN

Facility Name

Address

Phone number

Date

Table of Contents

RECORD OF CHANGES ..................................................................................................................................................... 2

1. GENERAL SAFETY INFORMATION ............................................................................................................................... 3

2. SCHEDULE OF REGULAR ACTIVITIES ........................................................................................................................... 4

3. CONTACT INFORMATION ......................................................................................................................................... 5

a. Internal Staff Members ................................................................................................................................ 5

b. External Support Agencies ........................................................................................................................... 6

c. Contact List for the Children (Parent/Guardians) ........................................................................................ 7

d. Approach to Sharing Emergency Plan with Families in Advance of Emergency ........................................... 8

4. ACCOUNTING FOR CHILDREN AND STAFF .................................................................................................................... 9

5. PLAN FOR COMMUNICATING WITH PARENT/GUARDIANS DURING EMERGENCY ............................................................... 10

6. INJURY/FIRST AID PLANS ...................................................................................................................................... 11

7. INSTRUCTIONS FOR SHUTTING OFF UTILITIES AND OTHER UTILITY INFORMATION ............................................................. 12

8. EVACUATION PROCEDURE ..................................................................................................................................... 13

9. SHELTER IN PLACE PROCEDURE .............................................................................................................................. 15

10. LOCK-DOWN PROCEDURE ................................................................................................................................. 17

11. EMERGENCY EVENT TYPE .................................................................................................................................. 18

a. Fire ............................................................................................................................................................. 18

b. Snow Storm/Severe Winter Weather ....................................................................................................... 19

c. Severe Thunderstorm/Tornado ................................................................................................................. 20

d. Bomb Threat and Suspicious Packages ..................................................................................................... 21

e. Epidemic/Pandemic/Infectious Illness ...................................................................................................... 22

f. Ginna Nuclear Power Plant/Nuclear Emergency ...................................................................................... 23

g. Hostile Individual/Gun Violence/Hostage ................................................................................................ 24

h. Utility Disruption ....................................................................................................................................... 26

i. Hazardous Material Release/Spill............................................................................................................. 27

j. Natural Gas Leak ....................................................................................................................................... 28

12. PLANS FOR CARING FOR CHILDREN AFTER HOURS ................................................................................................. 29

13. ASSEMBLY AND STORAGE OF GENERAL SUPPLIES (NON-FIRST AID SUPPLIES) .............................................................. 30

14. STORING CRITICAL DATA OFF-SITE ...................................................................................................................... 31

15. RESOURCES .................................................................................................................................................... 32

17.

APPENDIX A ................................................................................................................................................... 34

18.

APPENDIX B ................................................................................................................................................... 35

16.

KEY TERMS.. ................................................................................................................................................... 33

Emergency Plan for Child Care Facility

Record of Changes

Change Made

Section/

Page

Approved By

Date

1. General Safety Information

a. Facility Name:

b. Address:

Facility Emergency Telephone Number:

d. Local Autho

rities:

e. General Safety Procedures:

List safety procedures for the following:

(1) Entry

(2) Visitors

(3) Communication

(4) Oversight of Children (indoors and outdoors)

2. Schedule of Regular Activities

a. List Dates and/or Time Interval for Regularly Scheduled Tasks

Practice exercises

Event type 1:

Event type 2:

Event type 3:

ii.

Refreshing supply dates

iii.

Staff first aid training

iv. Updating child and staff contact and other background information

v. Checking contact information for emergency responders and relief organizations

vi.

Critical information back-ups and transfer to off-site storage

3. Contact Information

a. Internal Staff Members:

Job Title

Name

Business Phone

Home Phone

Mobile Phone

b. External Support Agencies:

Agency

Phone

Contact Name

Emergency- Police, Fire, EMS

911

Facility Medical Professional

Poison control

Fire (non-emergency)

Social Services

Primary Alternate Site (In Case of Evacuation)

Secondary Alternate Site (In Case of Evacuation)

Red Cross

c. Contact List for the Children (Parent/Guardians):

Child Name

Parent/Guardian

Name

Business Phone

Home Phone

Mobile Phone

d. Approach to Sharing Emergency Plan with Families in Advance of Emergency

4. Accounting for Children and Staff

a. Daily Attendance Procedure

b. Accounting for Children and Staff During E

mergency

ii. Responsibilities for accounting for child

ren and staff members.

The Facility Director:

Medical and Health Information

(The following information shall be attached to the Emergency Plan)

List of medication administration and medical emergency forms authorizing the

program to administer medications to the Children during an emergency or to seek

medical treatment for children requiring medical services.

ii. List of food

allergies of any children and or staff members.

iii. ID forms for the Children

i. The daily attendance of each child, staff member, volunteer and visitor is taken by:

ii. The daily attendance record will be kept (where?)

5. Communicating with Parent/Guardians During an Emergency

6. Injury/First Aid Plans

a. List First Aid Protocol

b. Incident/injury Forms

i. General

During the emergency event, it provides the means for recording incidents/injuries which

occur during the emergency. Appendix A contains the appropriate form.

Instructions for Shutting Off Utilities and Other Utility Information

8. Evacuation Procedure

a. General

i. When the conditions inside of the facility pose a threat to personal safety; leaving the

facility will reduce the hazard of the threat.

b. Evacuation Notification/Alarm

The facility evacuation notification/alarm system is:

c. Evacuation Routes and Meeting Areas

Each room in the facility has designated evacuation routes which lead to

designated meeting areas. These evacuation routes are posted in each room.

ii. Meeting areas

1. Area 1:

2. Area 2:

d. Selective Evacuation

A selective evacuation enables children and staff to escape the presented hazard (such

as a hostile individual) with minimizing risk. Groups of children and staff shall remain in

place until they receive notification to evacuate.

ii.

Evacuation to Alternate Site

i. When evacuation of the local area is required, the occupants of the facility may be taken

to the following locations

1. Alternate Site 1 (Primary):

2. Alternate Site 2 (Secondary):

ii.

Transportation to Alternate Site

1. Alternate Site 1 (Primary):

2. Alternate Site 2 (Secondary):

f. Evacuation Responsibilities

Facility Director:

g. Evacuation Communication with the Parent/Guardians

The procedure for notifying the Parents/Guardians about the Evacuation of the facility is:

9. Shelter in Place Procedure

a. General

Shelter in place is utilized in a situation where the conditions outside the facility pose a

threat to the

building occupants. Action shall be taken to prevent the threat from

entering the facility (Example: A hazard or an Intruder).

b. Shelte

r in Place Notification

i. The notification to shelter in place will be sent or made to the staff and children by:

c. Radiological, Chemical or Biological Agent

The facility will be secured by:

ii.

Actions taken to seal off air exchange within the building are to:

d. Police Searching for Fugitive/Criminal Suspect

When no immediate threat exists to the staff or children, the facility will be secured by:

e. Shelter in Place Communication with the Parent/Guardians

The procedure for notifying the Parent/Guardians with the implementation of the

Shelter in Place protocol is:

f. Shelter in Place Responsibilities

Facility Director:

10. Lock-down Procedure

a. General

i. Lock-down is utilized in a situation where the conditions inside the facility can pose a

threat to the personal safety of the building occupants and a facility wide evacuation

presents too much risk.

b. Lock-down Alarm/Notification

i. The notification to Lock-down the building will be sent or made to the staff and children

by:

c. Lock-down Protocol

The facility will be secured by:

d. Lock-down Communication with the P

arent/Guardians

The procedure for notifying the Parent/Guardians with the implementation of the Lock-

down Protocol is:

e. Lock-down Responsibilities

Facility Director:

11. Emergency Event Type

a. Fire

i. The Facility Director is responsible for:

All Other Staff:

b. Snow Storm/Severe Winter Weather

Responsibilities:

Facility Director:

All Other Staff:

c. Severe Thunderstorm/Tornado

i. Severe Thunderstorms

Severe Thunderstorm Watch (Severe Thunderstorm is possible)

Severe Thunderstorm Warning (Severe Thunderstorm is likely)

Tornado Watch (Tornado is possible)

Tornado Warning (Tornado is likely)

b. In the event of a Tornado, the designated safe area inside the building is:

iii.

Responsibilities:

ii. Tornado

Facility Director:

All Other Staff:

d. Bomb Threat and Suspicious Packages

i. General

1. Any bomb threat shall be taken seriously and treated as a real situation until

proven otherwise.

2. Evacuation of the building is to be ordered by the Facility Director or another

designated individual (See Section 8 “Evacuation Procedure”).

3. Upon arrival of the police, the Facilit

y Director or another designated individual

shall be available to assist the law enforcement team with any questions they

have.

4. No person enters the facility until the response team has been consulted and

the situation has been resolved.

ii. Bomb Threat Received Over the Phone

iii. Bomb Threat Received in Writing

iv. Suspicious Packages

v. Bomb Threat and Suspicious Package

Responsibilities

Facility Director:

All Other Staff Members:

e. Epidemic/Pandemic/Infectious Illness

i. General

1. An Epidemic is a disease that spreads more quickly through a population and

more extensively than normally expected.

2. A Pandemic is a disease that is effecting a large population across many

geographical boundaries; an extensive epidemic.

3. An Infectious Illness is any illness or disease caused by the entrance, growth and

multiplication of microorganisms in the body.

ii.

The Facility Director

is responsible for:

iii. In the event of an Epidemic/

Pandemic/Infectious Illness Emergency, communication will

be made with parent/guardians by:

f. Ginna Nuclear Power Plant/Nuclear Emergency

(For those centers/providers within the emergency planning zone of Ginna Nuclear Power Plant Only)

i. General

1. In

the event of a nuclear plant emergency, state and local officials are

responsible for emergency response planning, public notification and the

implementation of protective actions, if needed. When action is necessary, the

emergency response system will notify the public how to respond to the situation.

2. See the Emergency Planning Media Guide for public emergency

information:

http://www.cengllc.com/wp-

content/uploads/2011/12/Ginna_Emergency_Planning_Kit.pdf

ii. The Facility Director is responsible for:

iii. Communication with Parent/Guardians

1. Upon n

otification or alert of a nuclear situation, parent/guardians will be

notified of the situation by:

g. Hostile Individual/Gun Violence/Hostage

i. General

1. The procedure for a Lock-down is utilized.

2. Try to isolate the individual(s) from as many children and staff as possible. Seek

to draw the individual(s) to the office, break room, conference room or other less

populated area.

If the individual(s) enters a room occupied by children and staff, seek to draw

them away from the children and staff members.

4. Remain cal

m and be polite while attempting communication with the

individual(s).

5. Do not physically restrain or block the movement of the individual(s).

ii.

Potentially Violent Individual(s) Enters the Facility and Leaves

iii.

Potentially Violent Individual(s) Enters the Facility and Remains

iv.

Potentially Violent Individual(s) Outside of Facility (Without Entering the Facility)

v. Presence of Hostile Individual(s) Responsibilities

The Facility Director:

h. Utility Disruption

(Loss of electrical, heat and/or water service)

Responsibilities

i. Hazardous Material Release/Spill

General

The nature of a Hazardous Material Release/Spill will present various hazards

depending on the characteristics of the material and the magnitude of the

material release. Consultation with the local authorities will dictate the

actions taken by the Facility Director.

j. Natural Gas Leak

(Only applies if natural gas is used at the facilit

Information is from Rochester Gas and Electric (RG&E).

Website: http://www.rge.com/UsageAndSafety/naturalgassafety/dosanddonts.html

i. If you suspect a gas leak get up, ge

t out and call RG&E from a neighbor’s phone or cell

phone at 1-800-743-1702.

1. RG&E will respond quickly to ensure that you are safe.

2. Do not smoke or operate electrical switches or appliances. These items may

produce a spark that might ignite the natural gas and cause an explosion.

3. Do not assume someone else will report the condition.

4. Provide the exact location, including cross streets.

5. Let RG&E know if sewer construction or digging activities are going on in the

area.

ii. Use your senses to detect gas leaks. A natural gas leak is usually recognized by smell,

sight, or sound. Remember, if you smell natural gas, get up, get out and call RG&E

immediately from a neighbor’s phone or cell phone.

1. Smell

a. Natural gas is colorless and odorless. For your safety, a distinctive, pungent

odor, similar to rotten eggs, is added so that you’ll recognize it quickly. Not

all transmission lines are odorized.

2. Sight

a. You may see a white cloud, mist, fog, or bubbles in standing water or

blowing dust. You may also see vegetation that appears to be dead or dying

for no apparent reason.

3. Sound

a. You may hear an unusual noise like roaring, hissing, or whistling.

12. Plans for Caring for Children After Hours

13. Assembly and Storage of General Supplies (Non-First Aid Supplies)

Appendix B contains a list of suggested supplies to assemble.

The following link lists recommended supplies and quantities to have on hand to support 10 infants/toddlers for

24 hours. http://archive.ahrq.gov/prep/nccdreport/nccdrptapf.htm

14. Storing Critical Data Off-site

15. Resources

a. For additional information, the following resources can provide useful information:

ii.

General Services Administration; Child Care Emergency Preparedness

Toolbox http://www.gsa.gov/graphics/pbs/Child_Care_Emergency_Preparedness_Toolb

ox.pdf

iii. Promising Practices Network;

Emergency Planning Guide For Children-Servicing

Organizations http://www.promisingpractices.net/resources/emergencyprep/

iv. US Center for Child Development and Resiliency

http://uscenter.savethechildren.org/SitePages/Children%20in%20Disasters.as px

Disaster tips: http://uscenter.savethechildren.org/SiteAssets/SitePages/Children

%20in%20Disasters/Tips%20for%20Teachers%20and%20Administrators.pdf

vi. The New Hampshire Child Care Resource and Referral Network;

Family Child Care Emergency Preparedness

Guide http://www.dhhs.nh.gov/dcyf/cdb/documents/famcareprepguide.pdf

vii. Child Development Division and Healthy child Care Vermont;

Emergency Response Planning Guide for Child Care

http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/EmergencyResponse.pdf

The Annie E. Casey Foundation

Disaster Preparedness Resource guide for Child Care Agencies

http://www.aecf.org/~/media/Pubs/Topics/Child%20Welfare%20Permanence/Other/

DisasterPreparednessResourceGuideforChildWelf/DisasterPrep.pdf

ALL ASPECTS OF YOUR EMERGENCY PLAN MUST COMPLY WITH NY STATE REGULATIONS

Refer to Title 18 NYCRR subpart 418-1 regulations (Social Services: child day care centers)

The link below may not be the most current revision of the regulations, only use this link

as a reference point:

http://www.ocfs.state.ny.us/main/childcare/regs/418-1_CDCC_regs.asp

Key Terms

Alternate site: A location which can be safely occupied when the immediate area around the

facility needs to be vacated (i.e. a college, church or community center).

Emergency: Is when an event occurs that disrupts normal facility operational capacity.

Epidemic: Is when a disease spreads more quickly throughout a population and more

extensively than normally expected.

Evacuation: When all occupants need to leave the facility in a quick and organized fashion.

Facility Director: The individual who is responsible for all operations within the facility. They hold

the most authority within the facility from an organizational viewpoint.

Hazardous material: Any material which present health or safety risk to the environment or people

when it is not properly handled or contained.

Hostile individual: An individual who poses a risk to the safety of any facility occupants.

Lock-down: When the conditions inside the facility pose a threat to the safety of the facility

occupants, and a building wide evacuation presents too much risk;

Facility occupants seek cover in the facility and remain hidden from

plain sight.

Meeting area: When the facility is to be evacuated, the meeting area is a location outside of

the facility for the building occupants to gather for attendance and

await further instruction.

Notification/alarm: The communication made to the building occupants to inform them of the

emergency situation.

Pandemic: A disease that is effecting a large population across many geographical

boundaries; an extensive epidemic.

Procedure: A description for how to accomplish something; similar to a protocol, but is

generally less specific in description.

Protocol: A step-by-step description of how something is to be accomplished.

Selective Evacuation: During a lock-down, a facility-wide evacuation may present too great

of a risk but the opportunity presents itself to safely evacuate certain

parts of the facility.

16.

Shelter in place: When the conditions outside the facility present too great of a risk for the

Storm Warning:

Storm Watch:

building occupants to leave the facility.

Issued when the weather conditions allow for the weather event to be possible.

Issued when the weather conditions allow for the weather event to be likely.

INCIDENT/ INJURY REPORT FORM

CHILD’S NAME AGE

DATE

TIME OF INCIDENT/INJURY

LOCATION WHERE INCIDENT/INJURY HAPPENED

DESCRIPTION OF HOW INCIDENT/INJURY OCCURRED

PARTS OF BODY INVOLVED

TREATMENT GIVEN / ACTION TAKEN

TREATMENT GIVEN BY WHOM

NAME OF PARENT NOTIFIED TIME PARENT NOTIFIED

SIGNATURE OF PERSON NOTIFYING PARENT

CORRECTIVE ACTION NEEDED TO PREVENT REOCCURANCE

SIGNATURE OF STAFF DATE

SIGNATURE OF PARENT DATE

17.Appendix A

Emergency Supply Checklist

Facility Name:

Date Completed:

Person Completing Checklist: Manager:

Does your emergency kit include:

GENERAL SUPPLIES Date Replenished

●

First Aid Kit

●

Tissues

●

Whistle

●

Blankets (Mylar or other) #

●

Flashlight (with Extra Batteries)

●

Safety Light Stick

●

Battery-operated Radio (with Extra Batteries or Hand-

●

Disposable cups

●

Wet Wipes

●

Clorox Wipes or other disinfectant wipes

●

Handwashing solution

●

Notepad paper and pens

●

Scissors

●

Reflective Vest (For crossing streets)

●

Any items for children with special needs:

●

Age/ child specific needs: diapers, seasonal change of

●

Occupant Emergency Plan

●

Perishable Items* (*when possible, choose non-perishable food)

Expiration Date

●

Bottled water (preposition if possible)

●

Batteries for radio and flashlight

●

Critical medications for children & adults (insulin, epi-pens,

etc.)

●

Food (cereal, cheese & crackers, cans of fruit)

●

Infant formula

●

18.Appendix B

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