Emergency Preparedness Plan Template

Provider’s name: __________________________ Child’s name: ______________________________

Provider’s address: __________________________________________________________________

Provider’s Phone number: ___________________

Evacuation Plans

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) at _____________ (phone number).
  • 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 ___________________________________.

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 __________________.
  • “Shelter-in-place” supplies are kept ____________________________________ (location in the home).
  • I will check supplies every month and document on a Shelter-in-Place Drill form.
  • Mobile emergency kit supplies are kept _____________________________________ (location within the home). I will check supplies and practice monthly drills and record on an Evacuation/Fire Drill form. I will maintain supplies that are appropriate for the ages of children in my care.
  • In any emergency, I will contact Family/Emergency contacts to make plans to reunite the parent and child.
  • 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.
  • 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.

Communication/Notification Plan

  • 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 can not 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 e-mail: _________________________________ (name), ______________________ (phone), ___________________________________________ (e-mail 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_______
                          Date                                                                                   Date

Go to:
Emergency Preparedness and Supplies Guide

Go back to:
Apply for a Family Child Care Permit


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