Dup - Emergency Preparedness Plan for Child Care Providers Dup - Emergency Preparedness Plan for Child Care Providers Radio Buttons Family Child Care Child Care Center Section Date of Plan Original Training Date Training Participant Name * Program Name * OCC License Number Local Emergency Service Numbers Fire Department Ambulance Hospital Police Emergency Management Office Poison Control Center Local Office of Child Care Child Protective Services Health Department Electric Utility Gas Utility Water Utility Evacuation Site 1 Name Evacuation Site 1 Phone Evacuation Site 2 Name Evacuation Site 2 Phone Local Emergency Alert System (EAS) radio stations: Local Emergency Alert System (EAS) radio stations: AM FM For Family and Informal Child Care Neighbor: Phone #: Relative: Phone #: Substitute: Phone #: Persons Responsible for Emergency Response Section Person/Position Responsible Declare an Emergency: Call for Assistance: Contact Families: Decide to Evacuate: Contact Evacuation Site: Arrange Transportation: Complete Final Building Check after Evacuation: Determine End of Emergency: Media Spokesperson: Pet Arrangements: (if needed, if time allows) Account for All Children and Adults: (after emergency) Method: Maintain Disaster Supply Kit: (check regularly to replace & replenish) Carry Disaster Supply Kit: Location: Carry Children's Activity Kit: Location: Carry Needed Medication: Location: Carry Essential Document File: attendance sign in and sign out sheets contact information completed emergency cards care plans insurance information emergency plan Location: Section Alternate Declare an Emergency: Call for Assistance: Contact Families: Decide to Evacuate: Contact Evacuation Site: Arrange Transportation: Complete Final Building Check after Evacuation: Determine End of Emergency: Media Spokesperson: Pet Arrangements: Account for All Children and Adults: Maintain Disaster Supply Kit: Carry Disaster Supply Kit: Carry Children's Activity Kit: Carry Needed Medication: Carry Essential Document File: Emergency Communication Section Person/Position Responsible for Communicating Emergency Information: Items and Methods for Communicating in an Emergency: Cell Phones Walkie Talkies Location of Emergency Telephone Numbers: Section Alternate Person/Position Responsible for Communicating Emergency Information: Location of Communication Items: Person/Position Responsible for Maintaining Communication Items: Method for Maintaining Communication Items: Evacuation Locations A minimum of two (2) evacuation locations are required. Name of Location Address Phone Number Contact Person Formal Written Agreement? Yes No Due Date Name of Location Address Phone Number Contact Person Formal Written Agreement? Yes No Due Date Name of Location Address Phone Number Contact Person Formal Written Agreement? Yes No Due Date Children and adults (including non-walking children and disabled adults) will be transported to evacuation sites by: Natural Emergency Situations Description of natural emergency situations that occur most often in the child care site’s region: Procedures for responding to natural emergency situations: Manmade Emergency Situations Description of manmade emergency situations that are likely to occur: Procedures for responding to manmade emergency situations: Difficult Situations with Adults Procedures in place to deal with a parent, guardian or authorized person or employee who is impaired or in a disgruntled state: Evacuation Procedures Description of emergency situations that require evacuation: Procedures for evacuating including methods of communicating with families: Evacuation routes are posted and updated annually. Shelter in Place Procedures Description of emergency situations that require sheltering in place: Procedures for sheltering in place including methods of communicating with families: Lockdown Procedures Description of emergency situations that require lockdown: Procedures for entering lockdown including methods of communicating with families: Training, Preparation and Review Section Person/Position Responsible for Emergency Preparedness Plan Annual Review: Date of Review: Section Person/Position Responsible for Reviewing Emergency Preparedness Plan with Child Care Staff and Substitutes: Person/Position Responsible for Communicating Emergency Preparedness Plan with Families: Person/Position Responsible for Ensuring that Evacuation and Shelter in Place Procedures are Practiced with Children and Staff: Staff members who have completed approved Emergency Preparedness Training: Note: All staff must review and understand program's Emergency Preparedness Plan. Text Text plus1 Add minus1 Remove Procedures in Place to Safeguard Child, Staff and Program Records: Annual Plan Review Log Initials Date Initials Date Initials Date Initials Date Initials Date Initials Date This Section for Trainer Use Only I have reviewed this emergency plan and have determined that the information submitted above is complete. Trainer Name/Organization: Signature signature keyboard Clear MSDE Approval Number: Approval Date: Signature signature keyboard Clear If you are human, leave this field blank. Submit
