Family Emergency Plan Template

Family Emergency Plan

Fire • Police • Medical

Dial 9-1-1

 

Places to meet if family members become separated:

1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

 

Out-of-town relative for relaying messages to family members:

Name: ________________________________________________________________

Address: ______________________________________________________________

Phone: ________________________________________________________________

 

Family Information:

Father’s Work Address/Phone                                          Mother’s Work Address/Phone

_________________________________     __________________________________

_________________________________       _________________________________

_________________________________     __________________________________

                 

Child’s School Address/Phone                             School policy is to:

_________________________________       _____ Hold children

_________________________________       _____ Release children

 

Child’s School Address/Phone                             School policy is to:

_________________________________       _____ Hold children

_________________________________       _____ Release children

 

Utilities:

Gas shutoff: ____________________________________________________________

Water shutoff: ___________________________________________________________

Electric shutoff: __________________________________________________________

 

Emergency Supplies: (type and location) ______________________________________________________________________

______________________________________________________________________

 

Doctor: ___________________________       Dentist: ___________________________

Hospital: __________________________      Ambulance:_________________________

Medical insurance number: _________________________________________________

Nearest Medical Center: ___________________________________________________ 

Nearest Fire Station:______________________________________________________       

 

Poison Control Center: 1-800-876-4766