LDSS-7016. Plan for Fire, Disaster or Other Emergency Evactuation of Residents Operator or Substitute Caretaker

Form “Plan for Fire, Disaster or Other Emergency Evactuation of Residents Operator or Substitute Caretaker” is a document used by residential care providers to ensure their facility is prepared for any emergency situation that may arise. It is used to create a plan of action for an evacuation in case of fire, disaster, or other emergency.

The form consists of several key sections. The first section asks for information about the facility and its occupants, such as the name of the facility, the number of residents, and the contact information for the operator and substitute caretaker. This section also includes a space for the signature of the operator or substitute caretaker, indicating that they have reviewed and approved the plan. The second section details the plan of action in case of an emergency, including a description of the evacuation route, the location of the evacuation site, and the procedure for notifying emergency personnel, staff, and residents. The third section includes a list of emergency supplies and equipment that must be available at all times for the safety of the residents.

When filling out the form, it is important to pay close attention to the information provided in the second section. All evacuation routes should be clearly indicated with the exact location of the evacuation site specified. Additionally, the emergency contacts, such as the fire department, police department, and local emergency management office should be listed accurately. It is also important to ensure that the supplies and equipment listed in the third section are available and in good working order. This includes items such as fire extinguishers, flashlights, first aid kits, and emergency exit signs.

The form would be used by residential care providers in the event of an emergency, such as a fire or natural disaster. Having a plan of action in place is essential to ensure the safety of the residents in the facility. By having a plan and the appropriate supplies and equipment readily available, the operator and substitute caretaker can ensure the safe and efficient evacuation of the facility in the event of an emergency.

Specific instructions for filling out the form include providing accurate and up-to-date information regarding the facility and its occupants. Additionally, all emergency contact information must be correct and the evacuation route should be clearly indicated. It is also important to ensure that the necessary emergency supplies and equipment are in good working order and readily available.