Talk with your administrator. Complete this form with information from your program.

Child Care Program Information
Name of Program

Street Addresss

City

State

Zip Code

Telephone Number

Alternate Facility 1 (Program may operate in this facility if the main facility is not accessible)
Name of Facility

Street Addresss/Building Number

City

State

Zip Code

Telephone Number

Directions to Facility

Alternate Facility 2 (Program may operate in this facility if the main facility is not accessible)
Name of Facility

Street Addresss/Building Number

City

State

Zip Code

Telephone Number

Directions to Facility

Primary Point of Contact (Administrator) for my Facility
Name

Telephone Number

Alternate Telephone Number

Email Address

Emergency Contacts
Life Threatening Emergency 911
Non-Emergency Police

Non-Emergency Fire

Insurance Provider

Emergency Essential Personnel
Staff Name

Staff Name

Staff Name

Staff Name

Evacuation Plan
Evacuation Manager and Alternate

Person responsible for issuing all-clear

Assembly site manager and alternate

Assembly site location

Person able to handle medical emergencies

Location of evacuation exits

Location Nearby Assembly Site

Location of Distant Assembly Site

Location of More Distant Assembly Site

Shelter-In-Place Plan
Person responsible for issuing all-clear

Person able to handle medical emergencies

Storm shelter location

Person responsible for maintaining and refreshing emergency supplies

Location where personal supplies are stored (if staff must remain in building for extended period of time)

Location where children's supplies are stored for extended shelter-in-place events

Materials included in shelter-in-place kit

Evacuation Plan
Evacuation Manager and Alternate

Person responsible for issuing all-clear

Assembly site manager and alternate

Assembly site location

Person able to handle medical emergencies

Location of evacuation exits

Location of Nearby Assembly Site

Location of Distant Assembly Site

Location of More Distant Assembly Site

Lock-Down Plan
Person responsible for issuing all-clear

Person able to handle medical emergencies

Lock-down shelter locations in classroom

Lock-down shelter locations in common areas (playground, etc.)

General Emergency Plan
急救箱的位置在教室

Communications
How will emergency plans be communicated to me?

How will emergency plans be communicated to families?

How can I check in with my administrator following an emergency?

Adapted from Child Care Aware USA (2006) and Sample Emergency Plan