Emergency Response Plan for Employees Requiring Accommodations

Worker Name
MM slash DD slash YYYY
Plan Completed By & Title

Emergency Response Plan for Evacuation

Emergency Response Plan for Lockdown/Shelter in Place

Next Review Date:

*A copy of this form must be given to the worker and anyone involved in the emergency response plan for the individual.

Things to consider when creating individualized Emergency Response Plans
☐ Deaf and hard of hearing disabilities affect a person’s ability to hear alarms.

    • Consider alternative methods for notify the individual of an emergency situation such as:
      • Flashing lights.
      • Individual pagers/devices that can vibrate when alarms are set off.
      • Have individuals in the area assigned to notify the person.

☐ Visual disabilities may affect a person’s ability to identify escape routes, directional information, and objects/hazards in their path.

    • Consider the following:
      • Mark all emergency supplies with fluorescent tape, large print or braille.
      • Have canes available to help the induvial maneuver around obstacles
      • Have individuals in the area assigned to assist the person during an emergency. 

☐ Mobility disabilities may affect a person’s ability to independently leave the worksite, use the stairs or open doors.

    • Consider the following:
      • Assistive devices may need to be used to transport the worker throughout the workplace.
      • Have individuals in the area assigned to assist the person during an emergency. 

☐ Respiratory disabilities may affect a person’s ability to walk long distances to shelter or evacuation. These limitations may be made worse by smoke, dust, fumes or chemicals.

    • Consider the following:
      • Emergency Equipment may need to be used (i.e. masks, respirators).
      • The persons medication needs to be readily accessible (i.e. inhalers, EpiPen)
      • Have individuals in the area assigned to assist the person during an emergency. 

☐ Speech disabilities (i.e. difficulty with articulation, voice strength and language) may affect a person’s ability to communicate during an emergency.

    • Consider the following:
      • Have tools for written communication readily available (i.e. pen & paper, cell phone, table, small white board)
      • Have instructions written in clear language.
      • Have emergency cards with pictograms available so employees can communicate by pointing to various pictograms.
      • Have individuals in the area assigned to assist the person during an emergency. 

☐ Cognitive disabilities (i.e. memory loss, problems with orientation, perception) may affect a person’s ability to respond to emergencies properly.

    • Consider the following:
      • Have clear and simple signage and instructions.
      • Have alternative methods for notifying individuals of emergency situations. 
      • Have individuals in the area assigned to assist the person during an emergency. 

☐ Mental illness disabilities may be triggered or made worse in emergency situations.
☐ Consider accommodations for service animals if any are present.
☐ During an emergency there may not be any power – consider alternatives for assistive devices when needed.
☐ For evacuations, normal means of exit may be blocked so consider alternate exits.
*Remember all individualized emergency plans need to be practiced during regular drills.