PLAN
FAMILY EMERGENCY PLAN
Using a pencil, complete all sections below. Review the information annually and update if necessary.
Family Last Name:
Household Address:
Home Phone:
FAMILY/HOUSEHOLD MEMBERS INFORMATION
PET INFORMATION
HOUSEHOLD INFORMATION
EMERGENCY CONTACT NUMBERS
EMERGENCY NUMBERS
In Case of an Emergency: CALL 911
If 911 is not working, call the following numbers:
Police:
Fire:
Ambulance:
Hospital:
Poison Control: 1-800-222-1222 (US residents)
OTHER IMPORTANT NUMBERS
FAMILY CONTACT INFORMATION
FRIENDS AND NEIGHBORS CONTACT INFORMATION
OUT-OF-AREA CONTACTS
If our family is separated and unable to contact each other after a disaster, call the predetermined out-of-area contacts and report your location and condition.
Out-of-Area Contact #1
Name:
Address:
Home Phone:
Work Phone:
Cell Phone:
Email:
Out-of-Area Contact #2
Name:
Address:
Home Phone:
Work Phone:
Cell Phone:
Email:
EMERGENCY PLAN PROCEDURES
If our family is separated after a disaster, meet at the following predetermined locations:
Outside of Home Location:
Outside of Neighborhood Location:
Address:
Phone:
Directions:
WORKPLACE AND SCHOOL EMERGENCY PLANS
Complete the section below and attach copies of employer and school emergency plans.
1. Family Member’s Name:
❑ Work ❑ School ❑ Other:
Address:
Phone:
Meeting Location:
Procedures:
2. Family Member’s Name:
❑ Work ❑ School ❑ Other:
Address:
Phone:
Meeting Location:
Procedures:
3. Family Member’s Name:
❑ Work ❑ School ❑ Other:
Address:
Phone:
Meeting Location:
Procedures:
