Talk with your administrator. Complete this form with information from your program.
Child Care Program Information
| Name of Program |
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| Street Addresss |
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| City |
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| State |
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| Zip Code |
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| Telephone Number |
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Alternate Facilities
(Program may operate in this facility if the main facility is not accessible)
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Alt. Facility 1 |
Alt. Facility 2 |
| Name of Facility |
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| Street Address or Building Number |
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| City |
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| State |
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| Zip Code |
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| Telephone Number |
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| Directions to Facility |
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Primary Point of Contact (Administrator) for my Facility
| Name |
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| Telephone Number |
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| Alternate Telephone Number |
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| Email Address |
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Emergency Contacts
| Life Threatening Emergency |
911 |
| Non-Emergency Police |
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| Non-Emergency Fire |
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| Insurance Provider |
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Emergency Essential Personnel
| Staff Name |
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| Staff Name |
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| Staff Name |
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| Staff Name |
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Evacuation Plan
| Evacuation Manager and Alternate |
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| Person responsible for issuing all-clear |
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| Assembly site manager and alternate |
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| Assembly site location |
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| Person able to handle medical emergencies |
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| Location of evacuation exits |
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| Location Nearby Assembly Site |
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| Location of Distant Assembly Site |
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| Location of More Distant Assembly Site |
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Shelter-In-Place Plan
| Person responsible for issuing all-clear |
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| Person able to handle medical emergencies |
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| Storm shelter location |
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| Person responsible for maintaining and refreshing emergency supplies |
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| Location where personal supplies are stored (if staff must remain in building for extended period of time) |
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| Location where children's supplies are stored for extended shelter-in-place events |
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| Materials included in shelter-in-place kit |
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Evacuation Plan
| Evacuation Manager and Alternate |
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| Person responsible for issuing all-clear |
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| Assembly site manager and alternate |
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| Assembly site location |
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| Person able to handle medical emergencies |
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| Location of evacuation exits |
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| Location of Nearby Assembly Site |
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| Location of Distant Assembly Site |
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| Location of More Distant Assembly Site |
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Lock-Down Plan
| Person responsible for issuing all-clear |
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| Person able to handle medical emergencies |
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| Lock-down shelter locations in classroom |
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| Lock-down shelter locations in common areas (playground, etc.) |
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General Emergency Plan
| Location of First Aid kit in classroom |
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Communications
| How will emergency plans be communicated to me? |
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| How will emergency plans be communicated to families? |
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| How can I check in with my administrator following an emergency? |
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Adapted from Child Care Aware USA (2006) and Sample Emergency Plan available from the Federal Emergency Management Agency Ready website.
Infants & Toddlers
Safe Environments
Lesson 7
Apply
Emergency Preparation Forms
Program Tool