Free Emergency Preparedness Medical Checklist Template
Emergency Preparedness Medical Checklist
Prepared By: [YOUR NAME]
Date: November 27, 2050
Company Name: [YOUR COMPANY NAME]
Contact Email: [YOUR COMPANY EMAIL]
Contact Number: [YOUR COMPANY NUMBER]
Address: [YOUR COMPANY ADDRESS]
Personal Information
-
Full Name: [YOUR NAME]
-
Email: [YOUR EMAIL]
-
Emergency Contact Name: Duane Wiza
-
Emergency Contact Number: 222 555 7777
-
Medical History/Allergies: None
Supplies Checklist
|
Item |
Quantity Required |
Status |
|---|---|---|
|
First Aid Kit |
1 |
|
|
Prescription Medications |
30-day supply |
|
|
Emergency Food Supplies |
3-day supply |
|
|
Water (Per Person) |
3 gallons |
|
|
Portable Medical Devices |
N/A |
|
Emergency Contacts
|
Contact Type |
Name |
Phone |
|---|---|---|
|
Local Hospital |
SynoVita Hospital |
222 555 7777 |
|
Poison Control Center |
National Helpline |
222 555 7777 |
|
Workplace Safety Officer |
[YOUR COMPANY NAME] |
[YOUR COMPANY NUMBER] |
Action Plan
-
Ensure all emergency supplies are up-to-date and functional.
-
Review the emergency evacuation plan with the team by December 1, 2050.
-
Conduct a mock emergency drill on December 10, 2050.
-
Update emergency contact list by December 5, 2050.
