Personal Personal Emergency Evacuation Plan

Template

NAME First Name: Last Name:

Site where you are most of your time on campus Campus:
that will need help with evacuation in the event Building:
of an emergency Floor/Department:
Room No:
Issue Date: Review Date:

PERSONAL EMERGENCY EVACUATION PLAN

Have you practised the Emergency evacuation procedures?  YES NO 
What is your preferred method of receiving updates to the Emergency Management Plan and/
Emergency Procedures (e.g. email, SMS, verbal etc.)

Preferred method for Notification of an Emergency Evacuation (e.g. visual alarm, SMS, verbal etc.)

Type of assistance that may be required:

 Type Specific information  I may need this help/equipment to evacuate:

Visual

Hearing

Mobility

Other

Other Information:

Personal Evacuation Procedures and alternative safe refuge:

A copy of this PEEP should be given by the PEEP owner to a member of the ECO - the Building Warden, Manager of
Residences - IHD, ASSC or Katherine (if applicable) and campus Chief Warden and/or Security where you spend most
of your time.

Signed: PEEP owner: ………………………………………………............................................. Date: ….………………………………..

Name and Signature: - ECO member: …………………………………………………………….. Date: ………………………………….

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