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Emergency Plan

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An Emergency Plan ensures everyone in your household knows what to do in case of an emergency or disaster.




Your Emergency Plan

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___________________________ EMERGENCY PLAN
21 January 2025

This Emergency Plan is a written set of instructions to help you and your household handle evacuation or shelter-at-home emergencies. It is recommended that you review your Emergency Plan on a regular basis, preferably annually, to ensure that all information is recent and up-to-date.

Contact Information

Member Name and Primary Information

Secondary Information

Availability

Name:
Mobile:
E-mail:

 

N/A

Name:
Mobile:
E-mail:

 

N/A



Evacuation Plans

  1. Home Escape Route

    A Home Escape Route has been prepared by the household and is attached to this Emergency Plan.

  2. Home Evacuation Instructions

    In case there is a need to evacuate the house, all household members must go here:  

  3. City Evacuation Instructions

    In case there is a need to evacuate the city, all household members must go here:  

  4. Urgent Evacuation Items

    In case you need to immediately evacuate, you should grab the following items:
    Emergency kits, _______________________________________________________________ 

  5. Non-Urgent Evacuation Items

    If you have extra time before you need to evacuate, you may want to take the following items with you:
      

  6. Evacuation Emergency Contact

    In case you need to evacuate, contact this person to inform them that you need to leave your home or city, and that you plan to travel to their place or intend to stay somewhere else (e.g. community shelters, etc.).

    1. Name: ___________________________
      Address: _________________________________________
      Contact Number: ___________________________
      E-mail Address: ___________________________

Shelter-At-Home Plans

  1. Safe Indoor Location

    In case there is a need to stay home during an emergency, all household members must go to: ________________________________________________

Home Preparation

  1. Home Mechanical Systems

    Mechanical System

    Location

    Utility Company

    Water Valve

     

    Company Name:
    Phone Number:

    Electrical Panel

     

    Company Name:
    Phone Number:

    Heating System

     

    Company Name:
    Phone Number:

    Floor Drain



     

EMERGENCY KIT CHECKLIST

Use this checklist to create and prepare your emergency kit. It is strongly recommended that your kit contains enough supplies to keep everyone in the household safe and comfortable for at least 72 hours. The kit should be in something that’s easy to carry, such as a backpack, and kept in an accessible place. It is also advised that each household member have their own emergency kit.

After preparing your emergency kit, inform everyone in the household where it can be found. Update your kit regularly (preferably every 6 months) to ensure the food and medications in your kit are not expired and your documents are still up-to-date.

FOOD AND WATER

Item

Quantity

Expiration Date and Other Details

[   ] Bottled water (1gallon/person/day)

   

[   ] Canned and dried foods

   

[   ] Protein or energy bars

   

[   ]

   

[   ]

   

[   ]

   

[   ]

   

MEDICAL ITEMS

Item

Quantity

Other Details
(description, expiration dates, etc.)

[   ] First aid kit

   

[   ] Non-prescription medication

   

[   ] Medical equipment, if any

   

[   ]

   

[   ]

   

[   ]

   

SAFETY ITEMS AND BASIC EQUIPMENT

Item

Quantity

Other Details
(description, expiration dates, etc.)

[   ] Battery-operated radio

   

[   ] Flashlight

   

[   ] Batteries

   

[   ] Candles, and matches or lighter

   

[   ] Whistle

   

[   ] Utility knife or pocket knife

   

[   ] Manual can opener

   

[   ] Utensils

   

[   ] Sewing kit

   

[   ] Duct tape

   

[   ]

   

[   ]

   

[   ]

   

CLOTHING AND TOILETRIES

Item

Quantity

Other Details
(description, expiration dates, etc.)

[   ] Toilet paper or moist towelettes

   

[   ] Hand sanitizer

   

[   ] Garbage bags and plastic ties

   

[   ] Change of clothing per member

   

[   ] Sleeping bag or blankets

   

[   ] Diapers, if needed

   

[   ]

   

[   ]

   

[   ]

   

CASH AND DOCUMENTS

Item

Quantity

Other Details
(description, expiration dates, etc.)

[   ] Folder of important documents

   

[   ] Cash (coins and small bills)

   

[   ] Traveller's cheques

   

[   ] Emergency Plan

   

[   ] Local maps

   

[   ]

   

[   ]

   

[   ]

   

IMPORTANT DOCUMENTS CHECKLIST

Use this checklist to create and prepare your important documents folder. Ensure you are prepared for any kind of emergency by creating copies of your important documents and compiling them in a folder or binder.

After compiling, it is highly recommended that you store your folder in your emergency kit.

PERSONAL DOCUMENTS

MEDICAL DOCUMENTS

[   ] Driver's licences or identification cards

[   ] Health insurance cards

[   ] National insurance cards/documents

[   ] Health, life, disability insurance policies

[   ] Passports

[   ] List of medications (OTC and prescription)

[   ] Birth or adoption certificates

[   ] Immunization or vaccination records

[   ] Last Will and Testament

[   ] ______________________________

[   ] Living Will

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

   
   
   

PROPERTY DOCUMENTS

FINANCIAL DOCUMENTS

[   ] Mortgage documents

[   ] List of bank account numbers

[   ] Deeds, titles, leases for your home

[   ] List of investment account numbers

[   ] Deeds or titles for your vehicle

[   ] List of retirement/pension account numbers

[   ] Insurance policies

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________


FIRST AID CHECKLIST

Use this checklist to create and prepare your first aid kit. It is strongly recommended that your kit contains basic supplies needed to treat a variety of injuries. The kit should be kept together with your emergency kit.

After preparing your first aid kit, inform everyone in the household where it can be found. Update your kit regularly (preferably every 6 months) to ensure you have enough supplies and any medication you included is not expired.

BURNS

MEDICATION

[   ] Burn gel

[   ] Antihistamine

[   ] Burn dressing (4"x4")

[   ] Antacid tablets

[   ] ______________________________

[   ] Aspirin, Ibuprofen or Tylenol

[   ] ______________________________

[   ] Oral pain gel

[   ] ______________________________

[   ] Cold relief medicine

 

[   ] Rehydration pills or electrolytes replenisher

CUTS OR WOUNDS

[   ] Muscle relaxer

[   ] Regular bandages (different types & sizes)

[   ] Sleep aid

[   ] Gauze dressing pads (2"x2" or 4"x4")

[   ] Motion sickness relief

[   ] Trauma pads

[   ] ______________________________

[   ] Band aids

[   ] ______________________________

[   ] Nylon sutures

[   ] ______________________________

[   ] Surgical scissors

 

[   ] Adhesive tape

OTHER

[   ] Tweezers

[   ] Thermometer

[   ] ______________________________

[   ] Towel

[   ] ______________________________

[   ] Antiseptic wipes or soap

[   ] ______________________________

[   ] Eyepads

 

[   ] Gloves

SPRAINS

[   ] Safety pins

[   ] Finger splint

[   ] Ziplock bags

[   ] Flexible splint

[   ] Blanket

[   ] Elastic bandages

[   ] First aid manual

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

[   ] ______________________________

Last Updated December 26, 2024


Related Documents:

  • Last Will and Testament: Disasters may cause a sudden, unexpected loss of life. Use a Last Will to control the distribution of your estate once you pass away.
  • Advance Directive: Give consent to certain medical treatments in advance for when something leaves you incapacitated or unable to express your wishes.
  • Power of Attorney: Give someone the authority to act on your behalf for financial or property affairs.
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