Emergency Contact and Inventory Form

Small Safe Schools Plan District Name Street Address City Zip Code - draft Phone (760) 312 -5500 School Name Street Address City Zip Code Del Rio Community School 1501 “I” Street Brawley, CA 92227 Phone Page 1 of 3 (760) 312 –5601 ICOE – Alternative Education 253 E. Ross Avenue El Centro, CA 92243 Instructions: Please file annually by October 15th with your local Police and Fire Departments and with Imperial County Office of Emergency Services 1078 Dogwood Road Heber, CA 92249 Phone: (760) 482-2420 Fax: (760) 482-2407 attn: Rosa Hernandez rosahernandez@imperialcounty.net & Imperial County Office of Education 1398 Sperber Road El Centro, CA 92243 Phone: (760) 312-6434 (760) 312-6576 attn: David Schoneman jthornburg@icoe.org Phone Emergency Contact and Inventory Form For assistance contact Sharon Clay at (760)312-6151 Revised By: Elizabeth Goff Date: October 15, 2007 Emergency Phone Numbers: Name Director Principal Coordinator Facilities-Maintenance School Nurse District Bus Dispatch Master Key (1) Master Key (2) Organization Electric Company Gas Company Sewer Company Water Company Nearest Hospital Fire Station Police/Sheriff Dep. Other Phone Monalisa G. Vitela Grace Cortez-Jiminez Alejandro Avina Elizabeth Goff ICOE-Special Services N/A Maria Favela Carmen Miramontes (760) 343-8217 (760) 222-2417 (760) 577-2039 (760) 455-5371 (760) 312 -6424 ( )(760) 427-1883 (760) 312-5601 Imperial Irrigation District The Gas Company City of Brawley Pioneers Memorial Hospital 911 911 (760) 335-3640 (800) 427 -2000 ( )(760) 344-1550 (760) 351-3130 (760) 344-2222 (760) 344-2111 ( )- ⌧ ICOE Evacuation Sites Designate as a Primary, Secondary or Alternate Site Primary Secondary Location Area of Refuge #1 (See Map) Area of Refuge #2 (See Map) Shut Offs and Switches # of students/adults to be evacuated to site Electric 106/25 106/25 Gas Water (See Map) Maria Favela Maria Favela Telephones (See Map) Any On site Hazardous Materials Location (See Map) Maria Favela Contact Phone (760) 427-1883 ( ) (760) 427-1883 (760) 427-1883 ( )- Incident Command Team (responsible for directing and documenting on site emergency activities) Incident Commander Directs on site emergency operations Grace Cortez-Jiminez Monalisa G. Vitela John D. Anderson Anne J. Mallory Agency Liaison Officer Coordinates w/ outside agencies N/A N/A Alejandro Avina Backup Incident Commander Public Information Officer Backup Public Information Officer Backup Agency Liaison Officer Safety Officer Ensures emergency activities are conducted safely Backup Safety Officer Primary Secondary Incident Command Team Meeting Locations (Indicate locations where the Incident Command Team will convene during an emergency-Is there power and phone service?) Color key Students present in 2006-07 these team areas Admin Office; Conference Rm#A101 Admin Office; Meeting Rm#A-117 Staff assigned to teams in these areas should not have multiple assignments unless they are staggered during stages of incidents, e.g., search/rescue (start of event) and reunion gate (event has progressed beyond search/rescue) Information in this category represents districts resources to serve their students and to respond in the event of an emergency Small Safe Schools Plan District Name Street Address City Zip Code - draft Phone (760) 312 -5500 School Name Street Address City Zip Code Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Member 4 Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Meeting Location (inside): Del Rio Community School 2 Rm#C2-101A Page 2 of 3 Del Rio Community School 1501 “I” Street Brawley, CA 92227 Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Meeting Location (outside): Area of Refuge #3 Phone (760) 312 –5601 ICOE – Alternative Education 253 E. Ross Avenue El Centro, CA 92243 Team Assignments & Meeting Locations (Fill in Team Leaders, Alternates and Members. Indicate locations where team will convene during an emergency) Search & Rescue Team 1 Performs search & rescue operations by groups of classrooms, wings, or buildings. Number of Rescue Teams is based on number and location of classrooms. Maria Favela (Admin) Yolanda Benito (DR 1, OCS 1) Cylvia Cota (DR 2, OCS 2) Search & Rescue Team 3 Performs search & rescue operations by groups of classrooms, wings, or buildings. Number of Rescue Teams is based on number and location of classrooms. Meeting Location (inside): Del Rio 1 Conference Rm#C1-106 Meeting Location (outside): Area of Refuge # 1 Search & Rescue Team 2 Performs search & rescue operations by groups of classrooms, wings, or buildings. Number of Rescue Teams is based on number and location of classrooms. Meeting Location (inside): _____________________________ Meeting Location (outside): _____________________________ Search & Rescue Team 4 Performs search & rescue operations by groups of classrooms, wings, or buildings. Number of Rescue Teams is based on number and location of classrooms. Meeting Location (inside): _____________________________ Meeting Location (outside): _____________________________ Security / Utilities Team Ensure security of the school site and short-term repairs • • Fire Suppression / HazMat Team Extinguish fires & evaluate chemical spills Anthony Araujo Carmen Miramontes Meeting Location (inside): _____________________________ Meeting Location (outside): _____________________________ Crisis-Psychological First Aid Team Provides psychological counseling for students/staff District ⌧ ICOE Eduardo Meza Patricia Jones Special Services Special Services Supply / Equipment Team Ensure adequate supplies & equipment are available Meeting Location (inside): Admin Office Office A #A-102 Meeting Location (outside): Security/Utilities Team (outdoors) Assembly Area Team Ensures safe evacuation & accounting of all students/staff Antonia Mendez Leonila Moran Request / Reunion Gate Teams Process request(s) for student pick-up. Reunites parents or guardians at Reunion Gate Leader Alternate Leader Member 1 Member 2 Member 3 Leader Alternate Leader Member 1 Member 2 Member 3 Everardo Rodriguez Martin Tumbaga Keith Smith Meeting Location (inside): Del Rio Community School 1 Rm#C1-101A Meeting Location (outside): Area of Refuge # 1 First Aid / Medical Team Ensure first aid supplies are available & administered Meeting Location (inside): Del Rio Community School 1 Rm#C1-101A Meeting Location (outside): Area of Refuge # 1 Meeting Location (inside): Ocotillo 1 Rm #B-105 Meeting Location (outside): Area of Refuge # 2 Patrice Larson Karen Frisby Teresa San Roman Reunion Gate Teams (encourage a separate reunion gate be staffed if school enrollment exceeds 800) Meeting Location (inside): ______________________________ Meeting Location (outside): ______________________________ Communication School Safety Planning Committee Chair Documentation Primary Alternate PM Name Maria Favela Elizabeth Goff Maria Favela Chair Person Facilities Manger Color key Students present in 2006-07 these team areas Staff assigned to teams in these areas should not have multiple assignments unless they are staggered during stages of incidents, e.g., search/rescue (start of event) and reunion gate (event has progressed beyond search/rescue) Information in this category represents districts resources to serve their students and to respond in the event of an emergency Small Safe Schools Plan District Name Street Address City Zip Code - draft Phone (760) 312 -5500 School Name Street Address City Zip Code Del Rio Community School 1501 “I” Street Brawley, CA 92227 Phone Page 3 of 3 (760) 312 –5601 ICOE – Alternative Education 253 E. Ross Avenue El Centro, CA 92243 Plan for Loss of Utilities (Indicate specific plan for establishing alternative water, electricity, natural gas supply, and alternative methods of communication) Water: (Plan should include alternative water source for drinking water, fire suppression, food service & toilet) Drinking Water Gallons = 700 Food Service Emergency/Hygiene Kits =150 Fire Suppression Fire Extinguishers = 19 Toilet Emergency/Hygiene Kits = 150 Electricity: (Plan should provide alternative electrical source for ventilation & emergency lighting) Battery Lights N/A Ventilation N/A Generator (hours/days of power; what is powered; and fuel source) N/A Natural Gas N/A Food Service N/A Other Communication: (760) 427-1883 Nextel # 122*108005*13 Emergency Resources Inventory (Initial call out is made to the Authorization Contact from the Emergency Operations Center at the county or city. After initial call out, direct contact with Facilities, Staff, and Equipment Secondary Contacts may be made.) AUTHORIZATION CONTACT NAME phone location (1) Monalisa G. Vitela (760) 343-8217 Alternative Education Administration Office (2) Grace Cortez-Jiminez (760) 222-2413 Alternative Education Administration Office Facilities-secondary contact name Elizabeth Goff phone (760) 455-5371 location Del Rio Community School Gym-Multipurpose Room Capacity-# of people _N/A__ # of sq ft_______ # of restrooms________ # of showers _N/A__ Cafeteria Capacity-# of people __ N/A ____ # of sq ft_______ Type of Food Prep __N/A_______________________________ Classrooms Total #_4____ Other Staff- secondary contact name Tommilynn Estrada phone (760) 312-6424 location ICOE-Special Services School Psychologists # ___ - Through ICOE-Special Services School Nurses # ___ - Through ICOE-Special Services Certificates for CPR # Pending C e r t i f i c a t e s f o r E M T o r P a r a m e d i c s # N/A Bus Drivers # N/A Other Equipment- secondary contact name Elizabeth Goff phone (760) 455-5371 location Del Rio Community School # of vans 01 , capacity 8 People/Van radio frequency: no _X_, yes ___ frequency _________ Buses, capacity, radios Earthmoving equipment Type____N/A______________ Other emergency equip Cell Phone Radio (type+frequency) Color key Students present in 2006-07 these team areas Staff assigned to teams in these areas should not have multiple assignments unless they are staggered during stages of incidents, e.g., search/rescue (start of event) and reunion gate (event has progressed beyond search/rescue) Information in this category represents districts resources to serve their students and to respond in the event of an emergency