(SAMPLE)
EMERGENCY PLAN FOR (COMPANY)
FIRE MINOR ACCIDENT
That person sounds the alert to declare Injured person reports to ______
emergency
↓ ↓
If the fire extinguisher does NOT put the ______ gives first aid
fire out
↓ ↓
____ fills out Minor Accident Report
First person on the scene tries to put the
fire out with the appropriate type of
extinguisher
↓ ↓
Everybody evacuates the office via the Employee returns to work
nearest emergency exit
↓ MAJOR ACCIDENT
________ calls the required emergency First person on the scene notifies _____
services
↓ ↓
_______ gives first aid if needed ________ gives first aid
↓ ↓
Everybody is to meet __________ _____ calls the required emergency
services
↓ ↓
When emergency services arrive, _____ ____ fills out Major Accident Report
meets them
↓ ↓
__________gives the all clear signal Witness fills out Witness Report
↓
____ is to meet rescue services
↓
Worker MUST be left in place unless there
is a life-threatening situation
↓
Maintain scene until emergency services
arrive
Contact M0L
Always document what happened, why, what was done and what was learned
and give a copy of this document to the Health and Safety Coordinator.
The Health and Safety Coordinator forwards it to the Annual Action Plan.