Inspection checklist

					                                                     DT Safety
                                              Emergency Preparedness Self Assessment

Date of assessment:                      Location:

Assessment done by:

                           E-Mail this form to "Human Resources or the Safety Department"
FILL IN ALL BLANKS!          NA = Not Applicable        Y = Yes         N = No
       Are responsibilities assigned to key personnel to manage emergency response events?
       Has your company established an emergency organization/response team to handle events?
       Has personnel received emergency management/response training?
       Do you have an emergency response plan that provides instructions on handling emergency events?
       Has company personnel conducted walk through orientation meetings with their local fire station?
       Does your facility have a fire control panel box that provides smoke, water, or manual pull station alerts?
       Are your fire control systems supervised, and monitored by a local monitoring company?
       Emergency Evacuation Process:
       Is there a written emergency evacuation process established for this facility?
       Are new associates familiarized with the facility emergency evacuation process, and is the process simple to communicate?
       Does the evacuation process provide exiting instructions, to include closing doors and checking conference room?
       Are emergency assembly areas clearly marked outside (surface area and/or signs for snow environments)?
       Does the evacuation process provide a reliable means for collecting building headcount from each assembly area?
       Are secondary assembly areas, emergency command center, or medical triage areas identified?
       Are evacuation events investigated?
       Are emergency evacuation drills conducted at least annually?
       Are associates notified to evacuate via an audio alarm and/or flashing strobes?
       Medical Management:
       Is there at least two people per shift trained in adult CPR and Basic First Aid?
       Have trained personnel received Bloodborne Pathogen, or mass casualty incident training?
       Are adequate first aid supplies available for minor type of injuries?
       Are medical supplies available for a large scale medical event?
       Is there a process for collecting and reporting injured associate information?
       Emergency Escalation and Notification:
       Are internal emergency notification numbers provided to associates to report emergency events?
       Are company personnel selected to perform as an emergency response team, and are their phone numbers posted?
       Is the emergency management team notified by using an automated paging system?
       Are local emergency agency phone numbers available?
       Does your notification process include the TCOE VP, DST Systems, your BCP Planner, or Factory Mutual Rep?
       Managing the Emergency Event:
       Are critical equipment identified on a map with photo's of their shut down switches (UPS, Generators, Utilities, Gas)?
       Are floor plans provided for the building?
       Is there a method developed to assist the company incident leader with tracking the emergency event?
       Have company and media communication management been developed?
       Are supplies available for setting-up temporary operations (Emergency Command Center and Access Control)?
       Are hand-held radios and bull/mega horns available?
       Emotional Trauma:
       Is there a process developed for addressing emotional trauma (working with local agencies and EAP)?
       Is there a process developed for Notifying associates emergency contacts (who, when, and what to say)?
       Disaster Recovery Preparation:
       Are personnel trained to perform safety assessments once the local emergency agency releases the building?
       Regional Preparedness
       Are roof drains inspected prior to the wet season (Oct-May) to ensure water and snow melt can drain?
       Are exposed pipes and cold sensitive equipment winterized to prevent freezing conditions (Oct-May)?
       Are drainage areas maintained/cleared of vegetation and debris, and are flood control devices available?
       Does your facility have an early warning system for Tornados and strong wind events?
       Have you contacted your Loss Control Carrier for assistance in developing preparedness plans?


                                                                                                                       Safety First (Rev. 3/8/99)

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