School Emergency Response Plan Emergency Attendance Sheet printable pdf download

School Emergency Response Plan and Management Guide

Emergency Attendance Sheet

Teachers and staff: In the event a Universal Emergency Response is ordered, please complete the following Emergency

Attendance sheet. It will be collected or requested; wait for directions on the collection process.

Teacher Name:_____________________________________________________________________________

Evacuation

Lockdown

Severe Weather

Once completed, hold

Once completed, hold until

for collection.

requested by IC

or designee.

Number of individuals in room or with teacher: __________

Classroom No.: __________________

Students only

Students/others

Names of individuals, including adults in classroom or with

Individuals missing from room or assigned teacher:

reporting teacher NOT scheduled to be there:

______________________________________________

____________________________________________

______________________________________________

____________________________________________

______________________________________________

____________________________________________

______________________________________________

____________________________________________

______________________________________________

____________________________________________

Injuries (if any) or medical situations requiring attention:

Yes:

_____________________________________________________________________________________________

Signature: ______________________________________ Time:________________________________________

Lockdown Only:

Physical damage to classroom?

Yes:

_____________________________________________________________________________________

_____________________________________________________________________________________________

On the back of this sheet, please write the names of all individuals in the room or with teacher reporting.

Section 3: Emergency Response Plan – October 2009

School Emergency Response Plan Emergency Attendance Sheet