Visitor Name:
Contact Details:
If you are a member of staff, please also provide your internal contact details (if different from above)
Name of Host: / Contact details:
Reason for visit:
PLEASE COMPLETE AS BELOW
Date of completing PEEP: / Date of visit:
1. Which building(s) are you visiting?
You must state each building floor and all room numbers / areas as this may affect the plan
2. What is the nature of your impairment that would affect you escaping from the building?
3. Host to explain and show the emergency procedures of the building(s) to the individual, including escape routes, the use of safe refuge areas and evacuation lifts where relevant
Comment:
4. Host to clarify what arrangements will be put in place to ensure you are aware an emergency alarm has been activated, no matter where in the building you are, and that you need to evacuate. An example of this could be the use of a vibrating pager.
Details:
5. Do you need assistance from others to escape from the building? Yes No (please indicate)
If yes, ACTION– ASSISTANCE WHERE NEEDED, MUST BE AVAILABLE AT ALL TIMES
6. Do you need to use an evacuation chair? Yes No (please indicate)
If yes, ACTION– Host to identify appropriate type of chair, its availability and it’s location for use.
The host must ensure those using the chair are fully trained in how to do so safely and effectively
7. Who will provide assistance? / Contact details:
If you need assistance in another way, please say how and where.
ACTION– Host to ensure those providing the assistance are aware of the procedure(s) and are competent to provide the support required, including appropriate training where necessary.
VISITOR PERSONAL EMERGENCY EVACUATION PLAN onlineU (2).doc 1 of 427/09/2018