MANCHESTER METROPOLITAN UNIVERSITY.
PRELIMINARY EMERGENCY EVACUATION QUESTIONNAIRE FOR DISABLED PEOPLE.
1.1INTRODUCTION
1.2The University owes a duty of care to all students in respect of their health, safety & welfare. This duty extends to the provision of safe access and egress from our buildings.
1.3Students have an obligation to cooperate with the university in respect of health, safety and welfare issues.
1.4Therefore, the University may need to provide support and advice fordisabled people in the event of an emergency evacuation from our buildings. This process must be completed in good time;therefore,the completion of apreliminary questionnaire is required by all students who have identified a disability in their application.
1.5An evaluation of all completed questionnaires will be undertaken to ascertain whether the university will need to consult with you and develop a detailed Personal Emergency Evacuation Plan (PEEP) on your behalf.
1.6The University has a legal responsibility to protect you from fire risks and emergencies. A PEEP may need to be constructed based on the information you provide.
1.7Should a personal emergency evacuation plan be required you will be consulted on its content, be provided with any additional information necessary about the facilities, support and emergency egress procedures in the building(s) you attend.
2.1 ACTION
2.2The following short questionnaire must be completed and returned in the self-addressed envelope provided as soon as possible.
The questionnaire is divided into the following sections:
General
Mobility
Visual
Hearing
Please complete the ‘General’ section and any other that may apply.
3.1 GENERAL
3.2Name
Programme
3.3If possible, please identify the faculty where you will be based?
Faculty
3.3Do you currently have a carer or other personal support?
YesNo
4.1 MOBILITY IMPAIRED PERSONS
4.2.Could you raise the alarm if you discovered a fire?
YesNo
4.3.Could you open the fire escape doors on the floor(s) you will be using?
YesNo
4.4.Would you require assistance to exit a building in an emergency?(Please note lifts cannot be used in an emergency)
YesNo
5.5Could you use a telephone to call the emergency services?
YesNo
5.6Will you be a resident in university owned halls of residence?
YesNo
5.7Are you a wheelchair user?
YesNo
5.8What is the approximate width of your wheel chair?
5.9If you use another type of mobility aid, please provide details below
5.10Could you transfer to an Evacuation Chair (a specialist chair that can negotiate stairs safely) in an emergency with assistance?
YesNo
6.1VISUALLY IMPAIRED PERSONS
6.2Could you raise the alarm if you discovered a fire by operating the call point?
YesNo
6.3Can you open fire escape doors?
YesNo
6.4Can you use a telephone to call the emergency services?
YesNo
6.5Will you be a resident in a university owned hall of residence?
YesNo
6.6Will you require the emergency evacuation procedure to be on tape?
YesNo
6.7Will you require the emergency evacuation procedure in Braille?
YesNo
6.8Will you require the emergency evacuation procedure to be in large print?
YesNo
6.9Will you be able to read the fire escape signs?
YesNo
6.10Would you require assistance to exit a building in an emergency?
YesNo
7.1 HEARING IMPAIRED PERSONS
7.2Could you raise the alarm if you discovered a fire by operating a call point?
YesNo
7.3Can you use a telephone to call the emergency services?
YesNo
7.4Will you be a resident in a university hall of residence?
YesNo
7.5Will you be able to hear the fire alarm?
YesNo
7.6Will you require the emergency written procedures to be provided to you in an alternative format to the standard written instructions?
YesNo
7.7Do you require the written emergency procedures to be supported by BSL interpretation?
YesNo
7.8Will you require the provision of a hearing loop or similar device?
YesNo
8.1 FURTHER INFORMATION
8.2If you have any further information that you may think help us in supporting you while you are the university please detail below:
8.3Please sign and date the form below
NameDate
Thank you for completing this questionnaire.
The information you have provided will help us to meet any needs for information or assistance you may require
Please return the completed form to: