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Emergency Response Plan

(For Company XX)

Emergency 24 hour number ( ) Floor/Area Fire Warden ( ) Emergency Response Team Leader ( ) Emergency Response Team Deputy Manager ( )

(2)

Table of Contents

ABBREVIATIONS...4

DEFINITIONS...5

ABOUT THIS PLAN TEMPLATE...6

INTRODUCTION...8

EMERGENCY RESPONSE POLICY...8

Purpose...8

Scope...9

Executive Sponsor...9

Review and Compliance...9

Rules regulations...9

Staff responsible...9

Violations...9

EMERGENCY RESPONSE PLAN ...9

Purpose...9

Objectives...10

Assumptions...10

Scope...10

BUSINESS CONTINUITY PLAN DOCUMENTS & CRISIS RESPONSE PHASE...11

Business Continuity Plan Documents...12

EMERGENCY RESPONSE PLAN HIGH-LEVEL PROCESS FLOW...13

ERP Sub-phases...15

Plan Activation Phase...15

Incident Logging & Reporting Phase...15

Incident Evacuation Phase...16

Incident Assessment and Escalation Phase...16

Incident Mitigation Phase...17

Incident Prevention Phase...17

Incident Monitoring Phase...17

EMERGENCY RESPONSE TEAM STRUCTURE, ROLES, AND RESPONSIBILITIES...18

Emergency Response Team Leader (ERTL)...18

Emergency Response Team Deputy Manager (ERTDM)...18

Facility Security Manager...18

Security Guard...18

Evacuation Leaders (Floor Fire Wardens)...19

Medical Staff...19

Rescue Staff...19

Business Area Managers...19

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EMERGENCY RESPONSE TEAM LEADER (ERTL)...23

EMERGENCY RESPONSE TEAM DEPUTY MANAGER (ERTDM)...25

MEDICAL STAFF...27

FACILITY SECURITY MANAGER...27

RESCUE STAFF...27

PROCEDURES...28

ERP 1 - Emergency/Incident Reporting Procedure...29

Description... ...29

Emergency/Incident Reporting Procedure Steps... ...30

ERP 2 – General Emergency & Fire Evacuation Procedure...31

Description... ...31

General Emergency & Fire Evacuation Procedure Steps... ...31

ERP 3 – Bomb Threat Procedure...33

Description... ...33

Bomb Threat Procedure Steps... ...33

ERP 4 – Medical & First Aid Procedure...34

Description... ...34

Medical First Aid Steps... ...34

APPENDICES...35

A1 – Fire Evacuation Assembly Areas...35

A2 – Primary and Secondary Escape Routes & Assembly Area...35

A3 – Floor Plans...35

A4 – Emergency Supplies...35

FORMS...36

F1 – Initial Incident Report...36

F2 – Incident Assessment Form...37

F3 – Personnel Accounting Form (Headcount Form)...38

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Abbreviations

BCP Business continuity plan

CMC Crisis management center

CMT Crisis management team

BCP Business continuity plan

ERP Emergency response plan

ERT Emergency response team

ERTL Emergency response team leader

ERTDM Emergency response team deputy manager

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Definitions

Executive Sponsor

Senior management member who approves and provides full support for the development and implementation of the organization’s business continuity program

Document Manager

Person who approves and authorizes the ERP document including document revisions.

(6)

About This Plan Template

This emergency response plan (ERP) template is one in a series of templates designed to provide comprehensive, practical, and structured guidance to those responsible for developing an

emergency response plan and other related business continuity plan documents. This ERP template contains a recommended structure, outline, and contents for a typical emergency response plan document consistent with external authorities and responders and may be

customized and tailored to suite your organization’s specific emergency response requirements. It is recommended that a Document Manager be assigned the responsibility of overseeing

updates and revisions to this document. Please refer to the section “Version Change Control” for more information on how to manage and distribute changes to this document.

Business Continuity Plan Documents & Crisis Response Phase

For the purpose of this template, the crisis response phase has been defined as the overall phase during which a crisis situation or disaster occurs. During the crisis response phase, several sub-phases occur, namely, an emergency response phase, management response phase, and a business area response phase.

During each phase one of several business continuity plan documents are utilized. The diagram below depicts the crisis response sub-phases and plan documents associated with each sub-phase:

(7)

This business continuity plan template follows a phased approach as a response to a disaster or disruptive event. The [Company XX] business continuity plan consists of several plan

documents as follows:

1. Business continuity plan (referenced) 2. Emergency response plan (this plan) 3. Site crisis management plan (referenced) 4. Business area recovery plan(s) (referenced)

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Introduction

This [Company XX] Emergency Response Plan contains predetermined guidelines and procedures to ensure the safety, health, and welfare of staff, and an immediate response to an emergency or disaster situation. An emergency is any disruptive or harmful event that endangers people, environment, or an organization’s property and assets. Emergencies can be small, as in a fire contained by employees using fire fighting equipment, or large, as in a disaster resulting from an earthquake or a tornado. Example emergency events are:

• explosion

• overheated equipment

• airplane crash

• chemical spill in particular area

• fire

• pandemic

• loss of power

• damage to building

• loss of power

• damage from chemical spill

Example sources of emergency or disaster events are:

• smoking in building

• earthquake

• disaster in neighboring company facility

• storm

• disgruntled employee

• power generator failure

An emergency response plan deals with the immediate physical effects of a disaster and is used as an initial response. The emergency response plan is closely associated with the business continuity plan. The purpose of the business continuity plan is to ensure a prompt and efficient recovery of essential business operations.

Emergency Response Policy

Purpose

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Scope

This emergency response policy applies to all [Company XX] business facilities and locations. Each [Company XX] site shall define, approve, and implement an emergency response plan which includes essential activities, procedures, and tasks necessary to ensure an effective response.

Executive Sponsor

[Company XX] assigns a senior management member to be the “Executive Sponsor” who approves, sponsors, and provides full support the development and implementation of the organization-wide business continuity program and its constituent parts including this policy, emergency response plan, and other associated business continuity plan documents. The executive sponsor approves the budget and resources required, and delegates authority to the emergency response team and team leader to manage, coordinate, and oversee the emergency response plan design, development, implementation, maintenance, and assessment.

Review and Compliance

The corporate business continuity program policy has established an annual review and assessment for this policy and for the emergency response plan.

Rules regulations

[Company XX - rules and regulations that are specific to you organization here]

Staff responsible

[Company XX] business continuity and recovery teams have the responsibility to know this policy and understand and adhere to the standards and procedures established in this policy. It is the responsibility of all staff to be aware of their departments and/or business unit’s business continuity plan and its associated documents.

Violations

Any employee and/or contractor or service provider found to have violated this policy may be subject to legal actions such as termination.

Emergency Response Plan

Purpose

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1. Provide a managed, coordinated, and effective response to the immediate physical effects of an emergency or crisis situation.

2. Reduce the likelihood that the business continuity plans are invoked

Objectives

The primary objective of the emergency response plan is to protect life by: 1. preventing injury;

2. providing shelter; and 3. evacuating the premises. Additional objectives are to:

1. mitigate the threat of an emergency or disaster situation;

2. control and terminate the emergency or incident as quickly as possible; 3. prevent a minor incident from becoming a major disaster;

4. familiarize all members and staff with procedures; 5. protect environment;

6. protect company assets;

7. determine unsafe hazardous conditions and contaminations; and 8. minimize impact to business.

Assumptions

This plan has been developed with the following assumptions:

• All threats will be treated as genuine, until the incident investigation and assessment

proves otherwise;

• The Emergency Response Team will be comprised of sufficient number of staff to ensure

a satisfactory turnout in the event of an emergency.

Scope

(11)

Business Continuity Plan Documents & Crisis

Response Phase

For the purpose of this template, the crisis response phase has been defined as the overall phase during which a crisis situation or disaster occurs. During the crisis response phase, several sub-phases occur, namely, an emergency response phase, management response phase, and a business area response phase.

During each phase one of several business continuity plan documents are utilized. The diagram below depicts the crisis response sub-phases and plan documents associated with each sub-phase:

Each crisis response sub-phase is described below: 1. Emergency Response Phase

This phase is the first phase in managing a crisis. It comprises of the initial few hours after an actual disaster, or after the threat of a disaster is first identified. The emergency

response plan (ERP) is the primary document used during this phase.

In this phase, emergency response plan procedures, tasks, and forms are used; the business continuity coordinator and other members of the crisis management team are alerted; and evacuation occurs and/or the incident is contained.

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2. Management Response Phase

In this phase, the crisis management team manages and coordinates all site recovery activities. This phase begins after the initial response is received by the crisis

management team. The site crisis management plan (SCMP) is the main document used during this phase.

3. Business Area Response Phase

In this phase, business area teams recover and resume business operations. Depending on how large you organization is, you may opt to develop Business area recovery plans and

business unit recovery plans or just business unit recovery plans. Business area recovery

plans may be used to invoke business unit plans. Note that this breakdown allows for a more modular structure of activities and is especially useful if your organization is large has many business department and units.

Business Continuity Plan Documents

Below is a list of plan documents and an explanation of each:

Site Emergency Response Plan

o This plan. The ERP is used to respond to an emergency or incident. The primary plan objectives are to:

 Protect life

 Provide shelter

 Evacuate premises

 Mitigate threat and control extent of damage

Site Crisis Management Plan

o Plan used to manage and coordinate all site recovery activities including activities such as:

 Supervising recovery effort

 Declaring a disaster

 Invoking other plans

 Monitoring recovery, resumption, and normalization activities

Business Area/Department/Unit Recovery Plan

o Plan used to manage and recover business operations within each business area/department/unit.

(13)

Emergency Response Plan High-level Process Flow

During the emergency response phase and site crisis management phase, the Crisis Management Center will be opened and CMT team members will gather to determine if a disaster is to be declared. The following diagram illustrates the relationship between the ERP, SCMP, and the Business Area Recovery Plans:

The following process flow describes example high-level steps and actions conducted during the ERP phase. Activities in the plan start whenever there is a threat of disaster or an actual

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ERP Sub-phases

The ERP phase is divided into the following sub-phases: 1. Plan Activation Phase

2. Incident Logging & Reporting Phase 3. Incident Evacuation Phase

4. Incident Assessment and Escalation Phase 5. Incident Mitigation and Prevention

6. Incident Monitoring Phase

Plan Activation Phase

The emergency response plan may be activated as a response to any event that threatens the safety of employees, corporate assets, or environment. Activation of the emergency response plan occurs as a result of receiving notification of an emergency. Depending on the nature of the incident and the industry that your company operates in, invocation of the plan may be from internal sources such as an employee who notices a problem, or from an external source such as the World Health Organization (WHO), National Guard, or American Red Cross.

There are numerous events that can trigger the activation of the emergency response plan. Some examples of these events are:

1. a fire is detected on the main floor elevator; 2. a gas leak is detected in the basement floor; 3. a water leak occurs in the server room;

4. a goods production machine in the manufacturing facility is overheating; or 5. a hostage situation is in progress by a previous company employee.

The level of response will vary with each incident and there may be limited action, or a full response involving all team members and authorities.

The emergency response plan is designed to be executed prior to the execution of other business continuity plan documents; however, other plans such as the site management plan may be executed in parallel.

Incident Logging & Reporting Phase

When possible, the Emergency Incident Reporting Procedure shall be used to log an emergency incident. The Initial Incident Report shall be completed with the following information:

• Contact information – name, phone, date, and time;

• Description of emergency – problem description, injuries, property damage;

• Time of emergency event;

(16)

• Who was notified; and

• What actions have been taken

This form shall be delivered to the ERT Leader, Senior Management member, or other ERT Member.

Incident Evacuation Phase

If the emergency situation is life threatening, evacuate premises immediately by following procedures for:

• Fire Evacuation

• Bomb Threat

• Chemical Spill

• [Other Procedures for Company XX]

The ERT Leader shall ensure safety of personnel by ensuring appropriate evacuation procedure is followed.

Incident Assessment and Escalation Phase

The ERT Leader or other senior Management members are responsible for assessing the incident. The purpose of this assessment is to:

• Determine the urgency of the current emergency situation;

• Determine requirement for opening the Crisis Management Center;

• Determine requirement to activate other plans such as the business continuity plan;

The actual assessment assigns an incident severity level to the current situation such as low, medium, and high. Based on this assessment, other actions such as escalation may take place. The severity level may be based on extend of injury, possibility of containment, or other scenarios specific to your organization. Example severity levels are described below:

Low – incidents considered as low priority do not involve injury; can be contained easily,

and not likely to progress. In this severity level, the incident should be closely monitored to ensure it does not progress.

(17)

The incident is escalated based on results of the Incident Assessment Report which assigns an Incident Severity Level to the incident. The escalation serves the following purpose:

Ensures that the Incident Assessment Report is acted upon;

• Ensures proper authorities are notified such as ambulance or medical aiders;

• Action is taken to contain or minimize incident;

• Additional emergency response members are called; and

• Additional plans are invoked such as the business continuity plan.

Incident Mitigation Phase

In the event an emergency can be prevented from becoming a disaster, this phase attempts to take actions to contain or minimize incident such as:

o Calling ambulance;

o Calling medical first aid; and/or o Call salvage and repair experts

Incident Prevention Phase

In the event an emergency can not be prevented from becoming a disaster, this phase attempts to prevent further damage by:

o Administer first aid;

o Move items to second floor; o Prevent water damage; and/or o Ensure evacuation.

Incident Monitoring Phase

(18)

Emergency Response Team Structure, Roles, and

Responsibilities

An emergency response team is generally responsible for:

• personnel evacuations,

• internal rescue operations,

• medical assistance, and

• incident containment

Below is an example of a typical emergency response team, its members, and their roles and responsibilities. Note that this example team may not reflect your organization’s emergency response needs and therefore you should modify this structure as necessary:

Emergency Response Team Leader (ERTL)

• Primary director of emergency response team with overall responsibility for

emergency response phase.

• Coordinates emergency response activities together with ERTDM

• Assesses situation and escalate emergency together with other Senior

Management and ERT members

• Mobilizes ERT

• Primary responsible for formal plan activation, incident assessment, event

logging, and notifications

• Primary liaison with external authorities

• Primary responsible for establishing Crisis Management Center

Emergency Response Team Deputy Manager (ERTDM)

• Second in command director of emergency response phase and team.

• Together with ERTL, coordinates emergency response activities

• Together with ERTL, mobilizes ERT

• Together with ERTL, responsible for plan activation, incident assessment, event

logging, and notifications

• Secondary liaison with external authorities

• Secondary responsible for establishing Crisis Management Center

Facility Security Manager

(19)

• Provides support to ERT during incident

• Assist during evacuation

• Controls access to facilities

Evacuation Leaders (Floor Fire Wardens)

• Responsible for executing evacuation procedures, equipment shutdown, and

headcount

Medical Staff

• Responsible for providing immediate medical first-aid assistance

• Makes recommendations based on information received from rescue operators

and from health authorities

Rescue Staff

• Personnel specially trained in search and rescue operations

• Work closely with fire and ambulance departments

• Coordinate and liaison with external search and rescue

Business Area Managers

• Business area/unit leaders

Hazardous Material Handlers, Salvage and Repair

(20)

Emergency Response Contact Information

Emergency Response Team

Emergency Response Team Team

Member Function Work # Home # Cell # Email

Assistant / Secretary Emergency Response Team Leader (ERTL) Emergency Response Team Deputy Manager (ERTDM) Facility Security Manager Security Guard Fire Warden – Floor/Area 1 Rescue Staff Member Medical Staff Member Business Area Manager

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Emergency Response Team – Alternates

Emergency Response Team - Alternates

Team

Member Function Work # Home # Cell # Email

Assistant / Secretary Emergency Response Team Leader (ERTL) Emergency Response Team Deputy Manager (ERTDM) Fire Warden – Floor/Area 1 Rescue Staff Member Medical Staff Member Business Area Manager

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Emergency Response Team – Supporting Contacts

Emergency Response Team - Supporting Contacts

Function Business Alternate Comment

Regulatory Contacts Response Contractors Equipment Rental Emergency Pack Provider Protective equipment supplier

Emergency Response – External Authorities

Emergency Response – External Authorities

Function Main Local Additional Information

Police Fire

(23)

Emergency Response Team Tasks and Activities

Below are example responsibilities and tasks to be performed in the event of an emergency. Note that these are general tasks for each ERT member and may be modified to suite your

organization’s needs.

Emergency Response Team Leader (ERTL)

ERP Team Member: Emergency Response Team Leader

Task Action/Task Date/Time

Completed

□ Receive notification of incident;

Liaise with first responders such as police, fire, ambulance, etc if required.

□ Obtain ERP

□ Call other ERT members to assist

□ Determine if Crisis Management Center needs to be

opened:

If yes: agree on who will go to emergency site and who will open Crisis Management Center

If no: Manage incident by: Containing incident;

Monitoring situation and developments; Preventing further injuries.

At Emergency Site:

Assess Situation

□ Call Public Authorities

□ Follow Emergency Procedures

If fire, follow General Emergency and Fire

Evacuation Procedure

If injuries, follow Medical/First Aid Procedure

If bomb threat, follow Bomb Threat Procedure

At Crisis Management Centre:

□ Open CMT

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□ Work with CMT members (brief CMT Leader and provide status information)

□ If external response required: coordinate and liaison

with public safety authorities

□ If internal response only: manage incident by:

Containing incident;

Monitoring situation and developments; Preventing further injuries.

(25)

Emergency Response Team Deputy Manager (ERTDM)

ERP Team Member: Emergency Response Team Deputy Manager

Task Action/Task Date/Time

Completed

□ Receive notification of incident;

Liaise with first responders such as police, fire, ambulance, etc if required.

□ Obtain ERP

□ Call other ERT members to assist

□ Determine if Crisis Management Center needs to be

opened:

If yes: agree on who will go to emergency site and who will open Crisis Management Center

If no: Manage incident by: Containing incident;

Monitoring situation and developments; Preventing further injuries.

At Emergency Site:

Assess Situation

□ Call Public Authorities

□ Follow Emergency Procedures

If fire, follow General Emergency and Fire

Evacuation Procedure

If injuries, follow Medical/First Aid Procedure

If bomb threat, follow Bomb Threat Procedure

At Crisis Management Centre:

□ Open CMT

□ Ensure plans are available for everyone

□ Work with CMT members (brief CMT Leader and

provide status information)

□ If external response required: coordinate and liaison

(26)

□ If internal response only: manage incident by: Containing incident;

Monitoring situation and developments; Preventing further injuries.

(27)

Medical Staff

ERP Team Member: Medical Staff – Doctor/Nurse

Task Action/Task Date/Time

Completed

□ Perform medical first-aid assistance as required

□ Advise ERT Leader of any actions required

□ Contact health authorities, as appropriate

□ Contact nearest hospital(s), if required

□ Determine requirement to quarantine area and

equipment

Facility Security Manager

ERP Team Member: Facility Security Manager

Task Action/Task Date/Time

Completed

□ Provide controlled access to premises as required

□ Coordinate communications with ERT Leader

□ Liaise with public authorities as required

□ Assist with initial damage assessment with Damage

Assessment Team (DAT)

Rescue Staff

ERP Team Member: Rescue Staff

Task Action/Task Date/Time

Completed

□ Liaise with public authorities

□ Control safety equipment

□ Ensure link with Medical Staff, ERT Leader and/or

(28)

Procedures

Apart from the aid of public authorities, such as the police, fire, and ambulance services, and the direction of the Crisis Management Team (CMT), [Company XX]’s emergency response plan is the key internal emergency response in a crisis situation. Since a quick response is necessary in a crisis situation, the teams responsible for the following procedures must react without delay and without waiting for instructions from the Crisis Management Team.

The emergency response plan will ensure the following procedures are in place: 1. ERP 1 – Emergency Incident Reporting Procedure

2. ERP 2 – General/Fire Evacuation Procedure 3. ERP 3 – Medical/First Aid Procedure 4. ERP 4 – Bomb Threat Procedure 5. [Add other procedures as required]

(29)

ERP 1 - Emergency/Incident Reporting Procedure

Description

During a potential emergency or actual disaster situation, it is to the responsibility of ALL on-site personnel including employees, management staff, contract personnel, and visitors to report the incident.

If possible, the incident shall be reported to the following:

• Public Authorities (Police, Fire, Ambulance), if appropriate

• Emergency Response Team Leader or alternate

• Facility Security Manager

• Senior Management Staff

Example emergency events are:

• explosion

• overheated equipment

• airplane crash

• chemical spill in particular area

• fire

• pandemic

• loss of power

• damage to building

• loss of power

• damage from chemical spill

Example sources of emergency or disaster events are:

• smoking in building

• earthquake

• disaster in neighboring company facility

• storm

• disgruntled employee

(30)

Emergency/Incident Reporting Procedure Steps

If you detect a potential emergency situation, take the following steps. Note, this is a sample

procedure. The steps listed below may not accurately apply to your organization:

First Response During an Emergency

Ensure that staff, visitors, contractors, and public are safe before conducting other steps.

If possible, take the following steps: (If life threatening situation, evacuate premises)

1. Briefly assess situation using Initial Incident Report.

Note the following:

 Contact Information

 What is the Emergency is?

 Type of incident

 Time of incident

 Location incident

 Who was notified

 What action has been taken

2. Activate alarm, if necessary (e.g. in case of fire) 3. Alert Floor/Area Warden, if required

4. Alert Emergency Response Team Leader (ERTL) and/or:

Alert the Emergency Response Team Deputy Manager (ERTDM).

Alert the Facility Security Manager

Alert a Senior Management Staff Member

5. Alert Public Authorities (Police, Fire, and/or Ambulance service), if required

 Dial [911] and report your name, company, location, time, a brief

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 Use Medical & First Aid Procedure

ERP 2 – General Emergency & Fire Evacuation Procedure

Description

This procedure provides guidelines for evacuation. Consider the following during an evacuation:

• Assist others. For example, consider the needs of people with disabilities

• Outside Temperatures

• Where to evacuate to. For example, evacuate to a safer place, not into danger

Priority should be given to safety of staff and public. In general, you should ensure:

1. Everyone is accounted for;

2. Evacuation has been carried out;

3. Medical and First Aid staff attend to casualties, if required; and

4. Ambulance service has been called, if required.

General Emergency & Fire Evacuation Procedure Steps

If evacuation is required, take the following steps as necessary:

If you are NOT a floor warden:

8. Remain calm

9. Do not return to your office/work area 10. Activate Alarm

11. Alert Fire Warden

12. Alert the Emergency Response Team Leader and Facility Security Manager 13. Do not take valuable objects that hinder or block the evacuation routes 14. Leave the premises immediately by:

 Using the nearest escape route; and/or by

 Following the Floor Wardens instructions

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If you ARE a floor warden, follow Floor Warden Evacuation Procedure: (You are responsible for your assigned area)

1. If possible perform these tasks: a. Activate the alarm

b. Alert the Emergency Response Team Leader and Facility Security Manager

c. Commence evacuation of your area by providing clear instructions d. Guide staff to evacuation area

e. Do not use elevators

f. Ensure staff do not take large size objects

g. Ensure escape route is not congested; use alternate exit if possible h. Search the floor or area to ensure that no one is left behind

i. Check for abnormal conditions or objects (bomb threat etc)

j. Perform equipment is shutdown tasks (e.g. plant machinery should be shutdown, if practical)

k. Perform building shutdown tasks (e.g. ensure doors are closed, but not locked)

If this is a fire:

1. If safe to do so and condition permit, contain fire by ensuring all doors are closed 2. If safe to do so and conditions permit, extinguish fire using fire extinguishers

Repeated from Appendices:

A1 – Fire Evacuation Assembly Areas:

Site Evacuation Area 1 Evacuation Area 2

Company XX

Headquarte

Walkway area in front of main doors

(33)

ERP 3 – Bomb Threat Procedure

Description

Most incidents involving a bomb or explosive substances are not legitimate. However, because of the potential for harm, these threats are treated seriously. Note that a bomb threat may be received by either phone or through a written note or letter or by detecting a package on the premises.

Bomb Threat Procedure Steps

In the event information has been received that a bomb has been placed in building, take the following steps as necessary:

Do not touch or open the package or suspicious object

• Open doors and windows

• If possible, isolate the object where it can do no harm.

• Do not allow anyone near the object

• Notify the police. Follow their advise

• Notify the Emergency Response Team Leader

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ERP 4 – Medical & First Aid Procedure

Description

An adequately trained staff and a quick response are the most important elements when medical aid is to be provided.

Medical First Aid Steps

In the event of an emergency involving injury use the following steps:

• If possible, prevent further injury, especially if the head or neck are involved

• Consult external medical aid whenever possible

• Use first aid supplies and instructions whenever possible

• If an employees eyes or body have been exposed to hazardous or corrosive materials,

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Appendices

A1 – Fire Evacuation Assembly Areas

Site Evacuation Area 1 Evacuation Area 2

Company XX

Headquarte r Building

Walkway area in front of main doors

Rear entrance fenced area

A2 – Primary and Secondary Escape Routes & Assembly Area

List primary escape route List secondary escape route List assembly area

A3 – Floor Plans

List floor plans including:

• Location of alarms

• Location of fire extinguishers

• Gas and water lines

• Electric panels

A4 – Emergency Supplies

List emergency supplies:

• First aid supplies

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Forms

F1 – Initial Incident Report

Contact Information

Date: Time:

Contact Name:

Contact Phone Number:

Emergency Details

Problem Description: Personnel Injuries: Property Damage:

Time of emergency (when did it occur)? Date:

Time:

Location of emergency (where did it occur)? Who was notified?

Name:

Phone Number:

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F2 – Incident Assessment Form

Use this form to determine the extent of the emergency situation.

The actual assessment assigns an incident severity level to the current situation such as low, medium, and high. Based on this assessment, other actions such as escalation may take place. The severity levels may be based on extend of injury, possibility of containment, or other scenarios specific to your organization. Example severity levels are described below:

Low – incidents considered as low priority do not involve injury; can be contained easily,

and not likely to progress.

Medium – incidents considered medium priority involve minor injuries; may not be

easily contained, and have a chance of progressing.

High – incidents considered as high priority involve injuries minor or major; are not

easily contained, and have a high probability progressing.

Incident Assessment Form

Assessment conducted by (Name, Phone Number): Incident Severity Level Assigned:

Details of Injury (type, number of staff affected):

Likelihood of emergency progressing: Recommendations/Notes::

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F3 – Personnel Accounting Form (Headcount Form)

Site Employees Number of

Personnel Expected (e.g. from staff/visitor log) Number of Personnel Evacuation (Area 1) Number of Personnel Evacuation (Area 2) Company XX Headquarte r Building Staff Contractors Visitors Total

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F4 – Version Change Control

Version control is required in order to maintain integrity and cohesion of this document. The Document Manager should be the only person to approve and authorize changes and distribute revised versions.

To reduce the risk that an old version is used, the Document Manager should collect all copies of old versions before distributing new ones. This document shall not be photocopied. Additional copies should be obtained from the Document Manager.

Version

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