PERSONAL EMERGENCY EVACUATION PLAN
General Details
Occupants Name:
Location:
Building/Facility:
Floor:
Room Number:
Phone:
Evacuation Requirements
Is an Assistance Animal involved?
Yes
No
Is the occupant trained in the emergency response procedures:
Yes
No
Preferred method of receiving updates to the emergency response procedures:
e.g. text, email, Braille
Preferred method for notification of emergency:
e.g. visual alarm, personal vibrating service, SMS
Type of assistance required:
Equipment required for evacuation:
HRD-WHS-FRM-387.3
Personal Emergency Evacuation Plan January 2014
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