Emergency Response Plan Template
Provider’s name: __________________________ Child’s name: ______________________________
Provider’s address: __________________________________________________________________
Provider’s Phone number: ___________________
If there is an emergency that requires an evacuation of this home, one of the following plans will be used:
If the emergency requires that the children and I evacuate from my
home, I will take the children to _____________________________
(address nearby) at _____________ (phone number) or
_____________________________ (address further away) at _____________
If a medical examination or treatment is needed, I will take the
children to _____________________________________________ (facility and
address) unless emergency personnel designate another location.
If an emergency requires a larger area evacuation, I will take the
children to a mass shelter designated by emergency personnel.
If it is too far to walk, I will transport the children by
- I will practice evacuation drills every month and document on evacuation/fire drill form ( English, Spanish).
Emergency Preparedness Plan
- If there is an emergency where "Shelter-in-Place" is required, all the children and I will go to______________________________________ (room/place) in the home and remain there until rescued or notified that conditions are safe. I will sound the emergency alarm by____________________________ .
- Mobile emergency kit supplies are kept______________________________ (location within the home). I will check supplies and practice monthly drills and record on a Shelter in Place Drill form ( English, Spanish). I will maintain supplies that are appropriate for the ages of children in my care.
- I will stay with the children at all times during the emergency. I will check and record time and attendance before evacuation and whenever children are moved. I will bring any necessary medications, supplies, and essential emergency records/documents for the children.
- Shelter-in-place supplies are kept______________________________ (location in the home).
- In any emergency, I will contact family/emergency contacts to make plans to reunite the parent and child.
- I will train all adults who help care for the children about the emergency plans and procedures.
- I will post emergency evacuation and shelter-in-place routes and procedures in my home.
- I will review my emergency response plan every six months.
- I will talk to parents about my emergency plans or any changes in the emergency plan.
- I will update emergency contact information every six months with parents/guardian.
- I will notify parents by calling work, home, and/or cell phones, BlackBerries, pagers, e-mail or fax numbers, as applicable.
- The plan will include current phone numbers and names of individuals at the parent’s work site who can locate the parents if they are not at their work phones.
- If parents cannot be reached, I will contact the friends, relatives and neighbors who are authorized to pick up a child in an emergency.
- I will try to identify an out of town contact person that can be reached by phone or email: _________________________________ (name), ______________________ (phone), ___________________________________________ (email address).
- In the event that I receive different instructions from emergency personnel, I will make every attempt to contact parents/guardians/emergency contacts with the alternate plans.
Provider’s Signature Parent’s Signature Date
Provider is responsible for keeping emergency response plan information current with parents or guardians.
Provider’s Signature: _________________________________________
Six-Month Review________________ Parent’s Initials_______ One-year
Review ________________ Parent’s Initials_______
Go back to: Apply for a Family Child Care Permit