Please contact EOHSS at 24352 or to arrange for the set-up of your plan
McMaster University Individual Emergency Response Plan
This document is to assist supervisors in planning for emergencies which may occur to individuals with limitations. It is intended as a guide for items to be considered, it is not all encompassing. An individual emergency response plan is required for individuals identified under the Accessibility for Ontarians with Disabilities Act, Section 27.
Individuals Name: Date:
Cell phone # (or contact with any communications device)
Limitations reviewed in this plan [] mobility [] hearing [] visual [] speech [] cognition []
- Evacuation of the workplace only in an emergency [ ] or also in a drill? [ ]
Floor # Elevator available during evacuation ? [ ] yes [ ] no
Is this person working alone? [] yes [ ] no Does this person work after hours ? [] yes [ ] no
Emergency Phone #s
______
1)Primary emergency exit route:
2)Secondary emergency exit route:
3)Or safe waiting area:
Individual will have accompaniment at the safe waiting area [ ] yes
Individual will be left alone at the safe waiting area then this location is to be reported
to : contact #
by:
______
Persons who will provide assistance to this person in an emergency
1) contact:
2) contact :
3) Contact :
4)
Any special needs which thesepersons need to be aware of?
______
During loss of electrical power, evacuation plan is :
Other locations this individual may visit routinely during work or study?
Other items to consider:
Other emergencies to consider which may require individualized response – to be created as needed.
1)Threat of violence /harassment
2)Loss of electricity
3)Loss of consciousness
4)Allergic reaction Allergic to : contact:
5)Lockdown protocol
6)Spills/ odours, chemical or biological
This plan was prepared in consultation by :
Employee signature:
Supervisor signature:
EOHSS Representative signature:
Security Representative signature:
Emergency documentation used is acknowledged below
Emergency documentation for reference
[ ] AODA Info
[ ] McMaster campus emergency Guidebook :
[ ] Fire safety plan and procedures – Main campus and Residences (Not the HSC)
[ ] Hospital colour code emergency information for FHS:
[ ] McMaster accessibility offices
[ ] Emergency Notification info
[ ] Fire warden list
[ ] MUFA policy
[ ] Violence/harassment
Locations
______off Campus ______
[ ]Downtown Centre - Contact info for the City of Hamiton Mike Langille
[ ] MIP Contact info Jim Hyk ergency Number is 9-911
______Hospital associated ______
[] St Joseph’s Charlton Campus Stephanie Trowbridge RN, BSN(905)-522-1155 ext. emergency # 7777
[] St Joseph’s mountain site Stephanie Trowbridge RN, BSN(905)-522-1155 ext. emergency # 7777
[] St Joseph’s east end/Stoney Creek Stephanie Trowbridge RN, BSN(905)-522-1155 ext.
[] Juravinski Hospital contact Lili Brylowski Nestor
[] Hamilton General Hospital contact Lili Brylowski Nestor
[] David Braley Research Center Hamilton General Hospital site Leslie Steinberg
[] St Peters Hospital emergency 7777 contact Lili Brylowski Nestor
[] Chedoke Hospital Fire Emergency Number is 5555/Medical Emergency is 9-911/Security is 77753 contact Lili Brylowski Nestor
[] MUMC (McMaster) emergency # 5555 site contact Lili Brylowski Nestor
Please note that upon request this document can be made available in alternate formats