Assignment: Emergency Plan

You’ve
seen how an emergency plan works and learned why having one is a good idea. Now
it’s time to create your own! Use the form to help you fill in the correct information. Make sure you
submit your assignment once it is complete. Your assignment will be graded
based on the rubric.

Out-of-Town Contact
Name:

Telephone Number:

E-mail:

Neighborhood
Meeting Place:

Telephone Number:

Fill out the
following information for each family member and keep it up-to-date.

Name:

Date of Birth:

Name:

Date of Birth:

Name:

Date of Birth:

Name:

Date of Birth:

Name:

Date of Birth:

Name:

Date of Birth:

Identify Potential
Problems: Make a list of potential emergency situations in your area.

1.___________________________________________________________________

2.___________________________________________________________________

3.___________________________________________________________________

4.___________________________________________________________________

5.___________________________________________________________________

Home Escape Routes:
Make a list of each of the emergency home escape routes your family may need to
use.

1.___________________________________________________________________

2.___________________________________________________________________

3.___________________________________________________________________

4.___________________________________________________________________

5.___________________________________________________________________

Home Safety: In the
space below, make a home safety inspection schedule. Indicate the tasks that
need to be completed, who will be completing them, and when they need to be
done.