CAN-ASC-2.2 – Emergency Egress (Exit)
19. Annex B: Personal Emergency Evacuation Plans
Information
Table of contents
19.1 PEEPs general
A personal emergency evacuation plan (PEEP) is required for all individuals who may need assistance to evacuate a building in an emergency. A PEEP can be temporary or permanent.
A PEEP is generally for a specific individual (Employee PEEP).
A more generic PEEP template is for visitors (Visitor PEEP).
The contents of a PEEP will depend heavily on the abilities of the individual and the building they use.
19.2 Employee PEEP
This form is PRIVATE AND CONFIDENTIAL. Information will be retained by the Emergency Warden.
| Question | Answer |
|---|---|
| Name | |
| Phone Number | |
| Where will you be in the building (Floor/Room/Desk#) | |
| Will you be going to different/other buildings? If yes, give details. | |
| Do you require assistance in an emergency? | ( YES / NO ) |
| Do you require an alert in case of emergency? If yes, please indicate the best way to alert you. | ( YES / NO ) |
| Do you require assistance exiting using the stairs? If yes, please indicate the best way to assist you. | ( YES / NO ) |
| Do you require assistance going to the area of refuge? | ( YES / NO ) |
| Do you require assistance for comfort and assurance? If yes, please indicate the best way to assist you. | ( YES / NO ) |
| Do you have a “buddy” or “back up buddy?” If not, contact your manager. | ( YES / NO ) |
| Are you aware of the evacuation procedures? If not, contact your manager for a copy to review. | ( YES / NO ) |
| Are you aware of the nearest exits? If not, locate them in the emergency evacuation plan. | ( YES / NO ) |
| Are you aware of the Emergency Evacuation Plan that is posted? If not, review. Are you aware of the evacuation signage for persons with disabilities? If not, review | ( YES / NO ) |
| Is the evacuation signage in your preferred format? If not, request an alternate format. | ( YES / NO ) |
| Will any devices/equipment/procedures be needed to assist you in an emergency? For example, a wheelchair or evacuation device. If so, indicate the device/equipment/procedure here, and notify your buddy and manager. | ( YES / NO ) |
| If yes, are you aware of where the emergency device is stored? | ( YES / NO ) |
| Has this PEEP been developed in conjunction with you, the manager and emergency personnel? If not, inform your manager. | ( YES / NO ) |
| Any additional information that may be important in case of emergency? |
19.3 Visitor PEEP
This form is PRIVATE AND CONFIDENTIAL. Information will be maintained only during the duration of the visit.
| Question | Answer |
|---|---|
| Name | |
| Phone Number | |
| How long will you be visiting? | |
| Name and contact information for the person you are visiting (if applicable) | |
| Where will you be in the building (Floor/Room/Desk#) | |
| Will you be going to different/other buildings? If yes, give details. | ( YES / NO ) |
| Do you require assistance in an emergency? | ( YES / NO ) |
| Do you require an alert in case of emergency? If yes, please indicate the best way to alert you. | ( YES / NO ) |
| Do you require assistance exiting using the stairs? If yes, please indicate the best way to assist you. | ( YES / NO ) |
| Do you require assistance going to the area of refuge? | ( YES / NO ) |
| Do you require assistance for comfort and assurance? If yes, please indicate the best way to assist you. | ( YES / NO ) |
| Is the person you are visiting willing to assist you in an emergency? If not, notify security. | ( YES / NO ) |
| Are you aware of the evacuation procedures? If not, request a copy from security. | ( YES / NO ) |
| Are you aware of the nearest exits? If not, locate them in the emergency evacuation plan. | ( YES / NO ) |
| Are you aware of the Emergency Evacuation Plan that is posted? If not, review. | ( YES / NO ) |
| Are you aware of the evacuation signage for persons with disabilities? If not, review. | ( YES / NO ) |
| Is the evacuation signage in your preferred format? If not, request an alternate format. | ( YES / NO ) |
| Will any devices, equipment, or procedures be needed in order to assist you in an emergency? For example, a wheelchair or evacuation device. If so, indicate the device/equipment/procedure here, and notify the person you are visiting, or security. | ( YES / NO ) |
| If yes, are you aware of where the emergency device is stored? | ( YES / NO ) |
| Has this PEEP been developed in conjunction with you, the person you’re visiting, and the person responsible for emergency evacuation (receptionist)? If not, inform your manager. | ( YES / NO ) |
| Any additional information that may be important in case of emergency? |