.
Emergency Action Plan Assessmen
.
Emergency Action Plan Assessment
 
Hazard Description
Satisfactory
Needs
Attention
Target Date
for Completion
 
 
Date
Completed
Are you required to have an emergency action plan?
 Yes o No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Does the emergency action plan comply with all requirements and regulations?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Have emergency escape procedures and routes been developed and communicated to all employees?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Do employees who remain to operate critical plant operations before they evacuate know the proper procedures?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Is the employee alarm system recognizable and perceptible above ambient conditions?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Are alarm systems properly maintained and tested regularly?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Is the emergency action plan reviewed and revised periodically?
 Yes o  No o
 Yes o  No o
 
 
 
 
 
 
 
 
 
Do the employees know their responsibilities?
 Yes o  No o
 Yes o  No o
 
 
 
  
   For reporting emergencies?
 Yes o  No o
 Yes o  No o
 
 
 
  
   During an emergency?
 Yes o  No o
 Yes o  No o
 
 
 
  
   For conducting rescue and medical duties?                                  
 Yes o  No o
 Yes o  No o
 
 
 
 
Comments:
 
 
 
 

                                                                                                                                                                                               
 
Name ________________________________________________________________
 
Department ____________________________________________
 
Date ____________________________________