Emergency Management Plan Template

September 2022
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Emergency Management Plan
Template
September 2022

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Contact us if you need this information in an accessible format such as large print or
audio, please email Emergency Management Branch <EMPolicy@dffh.vic.gov.au>.
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Australia, Department of Families, Fairness and Housing, September 2022.
Available on the Department of Families, Fairness and Housing’s Service Providers Emergency
Management website <https://providers.dffh.vic.gov.au/emergency-management>.

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Contents
In case of an emergency....................................................................................................................7

Documentation information...............................................................................................................7
Validity Period.......................................................................................................................................7
Distribution............................................................................................................................................7

Purpose...............................................................................................................................................7

Scope...................................................................................................................................................7

Preparing for an emergency..............................................................................................................8

Service profile.......................................................................................................................................8
Clients and staff requiring additional support.....................................................................................10
Transport............................................................................................................................................10
Risk assessment................................................................................................................................11
Emergency Kit Checklist.....................................................................................................................11

Responding to an emergency.........................................................................................................13
Emergency Contacts..........................................................................................................................13
Incident Management Team...............................................................................................................14
Communication Tree..........................................................................................................................15
Emergency response procedures......................................................................................................16
Response procedures for specific emergencies................................................................................16
Area Map............................................................................................................................................17
Evacuation Map..................................................................................................................................17

Recovery...........................................................................................................................................18

Emergency Management Plan Completion Checklist..................................................................18

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[Services in scope of the Social Services Sector Emergency Management Policy must have an
emergency management plan. This Emergency Management Plan Template is a guide only and is
not mandatory. It is targeted at small to medium sized services. The template can be adjusted to
suit your service/facility.
This template does not include business continuity planning.
Refer to the Social services sector emergency management policy and the Preparing for
emergencies: a reference guide for the social services sector for additional information, available on
the Service Providers’ Emergency Management website
<https://providers.dffh.vic.gov.au/emergency-management>.
Delete all blue instruction text in brackets]
[Insert Service Logo]

[Insert service name]

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Emergency Management Plan Template 7

In case of an emergency
ALWAYS CALL 000 (TRIPLE ZERO) IF THERE IS AN IMMEDIATE DANGER TO LIFE

For advice, call your management representative: [insert contact details]

Convene your Incident Management Team.
Notify your department Division on [insert contact details] if the emergency results in changes to
service delivery, and again when normal services have resumed.

Documentation information
Validity Period
[Insert how long the plan is valid for, the authorised person/committee approving the plan, and when
the plan will be reviewed.]

Distribution
[Insert the appropriate receiver(s) of the plan.]

Name Position Title and Date Email Address or

Organisation Name Sent Postal Address

Purpose
This Emergency Management Plan (plan) provides details on how [insert service name] will prepare
for and respond to emergencies.

Scope
This document outlines [insert service name]’s emergency management arrangements. This plan
applies to all clients, staff, contractors, and visitors associated with this service.

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8 Emergency Management Plan Template

Preparing for an emergency

Service profile

General Information
Service Name
Physical Address
Operating Days
Operating Hours
Phone
Email
Fax
Website
Number of buildings/sites
Relocation Location /
address and phone number
Number of service users
Total Number of Staff
Methods used for
communications to our
service’s community

Other services / users of facilities (if applicable)

[Provide details of other users of your facility. This may include community groups that use the
facility during the evening or weekends.]
Note: if more than one organisation operates from any of your facilities, each organisation should
have its own emergency management plan.]

Service / User’s Name

Location
Service user / Visitor
Numbers
Operating Hours/Days
Emergency Contact Name
Phone Number
Mobile Number

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Building information summary

[In this section, provide the fire and emergency safety features of the building/s on your site/s, as
well as any known building and site hazards, for example chemical or fuel storage. Replicate this
information for each site.]

Fire suppression systems

System Location
[e.g. extinguisher [Ground Floor / Level 1 / Room 1.1 / Foyer
sprinkler system Location of Control Valve]
fire hose reels/blankets]

Alarms

Alarms Location Monitoring Company Location of Shut-off

Instructions
Fire:

Intruder:

Other: [e.g.
duress
alarm]

Utilities

Utilities Location Service provider Location of Shut-off

Instructions
Gas /
Propane:
Water:

Electricity:

Communication systems

System Location
[e.g. emergency exit signs /
lightening
Two-way radio]

Building and site hazards

Hazard Description Location

[e.g. hazardous chemicals]

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10 Emergency Management Plan Template

Clients and staff requiring additional support

[People have individual assistance and communication needs. Multiple communication channels
and formats should be available for use by individuals and organisations involved in disaster
prevention, preparedness, response, and recovery.
Identify service users and staff who may need assistance in an emergency. The list must be kept up
to date and include individuals who (add additional as required based on your client profile):
• have a medical condition which requires a medical management plan (for example, asthma)
• are recovering from an accident or illness
• have a vision, hearing or ambulatory impairment
• have an intellectual disability
• use a wheelchair or scooter
• are aging
• are non-English speakers.]
Service users/staff requiring additional support may like to create their own emergency
management plan.
More information can be found in the Preparing for emergencies reference guide, available on the
Service Providers’ Emergency Management website <https://providers.dffh.vic.gov.au/emergency-
management>.]

Service users or staff requiring additional support

Name Room/area/location Condition Assistance needed Who will be

during an responsible
emergency
[insert [e.g. Level 1] [e.g. impaired [Will require [insert name]
name] vision] assistance during
evacuation]

Summary of additional support

Additional Support Category Number of service users Number of staff

[e.g. asthma, wheelchair]

Transport
[If necessary, include your organisation’s emergency transportation plan to alternative locations to
maintain service continuity and safety. Ensure the type of transport is appropriate for your clients.
For example, wheelchair accessible vehicle as required.
Services which must contain a transport plan in their emergency plan are:
1. Supported independent living and short-term accommodation and assistance services
2. In-home and community-based services
3. Residential care services
4. Homelessness services]

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Risk assessment
[Assess the types of emergencies that are likely to affect your facilities/sites or service users.
Results of the risk assessments should be incorporated into the emergency management plan.
Identify the hazards to your service and the associated risks they carry that could lead to an
emergency at your facility.
More information and a sample hazard risk assessment template can be found in the Preparing for
emergencies reference guide available on the Service Providers’ Emergency Management website
<https://providers.dffh.vic.gov.au/emergency-management>.]

Emergency Kit Checklist

[Pre-prepared kit containing relevant emergency information and equipment could save valuable
time and resources in the event of a relocation or evacuation. Contents should be checked
regularly, particularly if any perishables are included in the kit. Service providers should be aware of
any specific requirements your clients may have and adjust your kits accordingly.
For more information regarding emergency kits visit http://www.ready.gov/kit.
<https://www.ready.gov.kit>.]

The Emergency Kit Contains:

Service’s information
List of emergency contacts and staff information (contained in the plan)
Service users’ data and next-of-kin contact information (contained in the plan)
Service users and staff with additional support list (contained in the plan) including any
service users’ medications and cool packs/care plan/identification
Copy of facility site plan and the plan including evacuation routes
General equipment and supplies
Wool blanket
Facility keys
Standard portable First Aid Kit and its location
Service user evacuation travel kit (if applicable)
A charged mobile phone and charger/s (batteries checked and charged)
Torch with replacement batteries or wind-up torch (batteries checked and charged)
Whistle
Portable battery powered radio (batteries checked and charged)
Pens, markers, paper
Bottled water (use by date checked)
Portable non-perishable snack (use by date checked)
Sunscreen and spare sunhats
Plastic garbage bags and ties

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12 Emergency Management Plan Template

Toiletry supplies
Antibacterial wipes, hand sanitiser gel and surgical face masks
Clothes made from natural fibres, sturdy shoes or boots and heavy-duty gloves
Date Emergency Kit Checked:
Next check date:

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Responding to an emergency
Emergency Contacts

Emergency Services
ALWAYS CALL 000 (TRIPLE ZERO) IF THERE IS AN IMMEDIATE DANGER TO LIFE

Our Service Contacts

[Note: This plan includes a field for staff member(s) responsible for Bulk Messaging (where SMS
system is in place). This person may not be the same person as the communications person in your
Incident Management Team structure. The staff member responsible for bulk messaging should act
under the guidance of the communications person in your IMT structure.]

Key organisational roles

Key Roles Name Phone Phone Mobile

(After Hours)
Approved Provider or
Person with Management
or Control Representative
Responsible Person /
Primary Nominee
First Aid Officer
OHS Representative
Bulk Messaging System
Operator (e.g. SMS)

Key organisational / department contacts

Position Name Phone Mobile

Emergency Evacuation / North Division 1300 080 829
relocation contacts West Division 1800 780 354
East Division 1300 576 518
South Division - Gippsland 1300 528 951
South Division - Southern Metro 1800 309 916
[Delete those not applicable]
Department Program
and Service Adviser
[person with who you
discuss your funding and
service agreement with.]

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Local / other organisations contacts

Organisation Name Phone Location/address
Service’s evacuation location number
Police Station
Hospital/s
Gas
Electricity
Water Corporation
Facility Plumber
Facility Electrician
Local Government
VicEmergency 1800 226 226
WorkSafe Victoria 1800 136 089
[Insert other contacts that your facility may
call upon to assist during an emergency]

Service users / staff primary emergency contacts

[Note: Please remove service users and staff identifying details from this section before distributing
copies of your plan to organisations or individuals outside your service/facility to guarantee
adherence to the provisions of the Information Privacy Act 2000]

Service user / staff Primary emergency Phone number Mobile phone

name contact name number

Incident Management Team

Your Incident Management Team (IMT) will direct the way your facility will respond to an
emergency.
Your IMT may (or may not) follow your corporate structure or fire warden structure/emergency
management team, depending on the nature of the emergency and the size of your organisation. In
a small facility there may not be enough staff to assign each IMT role to a different person. In such
cases, staff members can take on multiple roles. For example. Chief Warden/Commander can take
on logistics and communications role.
[Record all contact roles relevant to your facility and enter this table in your plan.]

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Incident Management Team contact details

Title Name Contact number

Chief Warden/Commander
Deputy Chief Warden
Operations Officer/Warden
Logistics Officer/ Warden
Communications Officer
First Aid Officer

[The following is an example of an IMT structure for a medium organisation. Please consider the
size of your organisation and adjust your IMT structure appropriately.]

Figure 1 – Example Incident Management Structure

Communication Tree
[A communication tree enables you to easily identify who at your facility will contact the relevant
person or organizations such as emergency services, the department Division and service
users’/staff’s primary emergency contact in the event of an emergency.
Depending on the size of your service, you may wish to include more than one communication tree
in your plan.]

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Figure 2 – Example communication tree

Emergency response procedures

During an emergency it may be necessary to activate one or a combination of the following
emergency procedures:
• Altering or ceasing services
• Relocation
• Evacuation
• Shelter-in-place
• Shelter indoors
[More information can be found in the Preparing for emergencies reference guide, available on the
Service Providers’ Emergency Management website <https://providers.dffh.vic.gov.au/emergency-
management>.
Service Providers will need to apply good sense of judgement when actioning any emergency
procedures as the circumstances of the emergency need to be considered in your response. These
procedures should be modified to incorporate any specific modifications/additions arising from your
risk assessment.]

Response procedures for specific emergencies

[First you complete your risk assessment and identify threats and hazards to your service. Include in
this section your planned preparation for, response to, and recovery from these threats and
hazards.
More information can be found in the Preparing for emergencies reference guide, available on the
Service Providers’ Emergency Management website <https://providers.dffh.vic.gov.au/emergency-
management>.
You will need to exercise judgement when implementing response procedures during an emergency
as the circumstances of the event will need to be considered in your response.]

Bushfire
[Provide your bushfire plan here.]

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[More information can be found in the Preparing for emergencies reference guide and the Social
services sector emergency management policy, available on the Service Providers’ Emergency
Management website <https://providers.dffh.vic.gov.au/emergency-management>.]

Catastrophic fire danger day

[Services within the scope of the Social services sector emergency management policy, which
operate home based care or residential care in areas of heightened risk, and services/facilities of
which the weather district is subject to a Catastrophic fire danger day must comply with required
Catastrophic fire danger day actions contained in the policy. These actions are specified in the
individual carer’s Leaving Early Plan or residential facility’s Bushfire Survival Plan.]
Services within scope of the Social services sector emergency management policy are required to
report to the department within 5 days of the Catastrophic fire danger day that services have
resumed or when the service is expected to return to normal.
[Insert your Catastrophic fire danger day procedure here.]
[More information can be found in the Preparing for emergencies reference guide and the Social
services sector emergency management policy, available on the Service Providers’ Emergency
Management website <https://providers.dffh.vic.gov.au/emergency-management>.]

Area Map
[Insert an area map to show the location of your facilities/sites and its off-site evacuation points. It
should include:
• surrounding streets (including street names)
• exit points from your service
• emergency services access points
• a minimum of two off-site assembly areas (where possible)
• off-site evacuation routes (coloured green)
• major landmarks
• legend.
Your area map should also specify the distance and estimated time it would take to get from your
facility to each assembly point.
You can generate your area map using a computer mapping program (for example from the
internet). If this is not possible, a copy of the relevant map from a street directory will suffice.]

Evacuation Map
[Evacuation diagrams for each building and floor are required to be displayed in all locations where
service users, staff, visitors, and contractors can view them. This may include reception area,
corridors, meeting rooms, break room and so on your emergency management planning team
should determine the number and siting of evacuation plans required for each building.
Insert your facility’s evacuation map here. Refer to the Australian Standard 3745-2010 Planning for
Emergencies in Facilities to ensure your evacuation map meets relevant requirements.]

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Recovery
[Refer to your Business Continuity Plan and other recovery activities.
More information can be found in the Preparing for emergencies reference guide, available on the
Service Providers’ Emergency Management website <https://providers.dffh.vic.gov.au/emergency-
management>.

Emergency Management Plan Completion

Checklist
This completion checklist has been developed for use as a ‘final check’ to assist you to confirm that
you have completed all the components of your plan.

Component P/O Action Required

Distribution list has been completed
Site profile has been populated and reflects the service’s
general information, other services/users of site and
building information summary
Service users and staff requiring additional support have
been identified and strategies are put in place for these
persons in the event of an emergency
A transportation plan has been completed
Potential local hazards have been identified
Risks have been rated and risk assessments included
Local mitigations/controls have been specified
Emergency Kit Checklist has been completed
Appropriate key local community contact numbers have
been added for example Fire, Ambulance, Police, local
government, nearest hospital
Key contact numbers for internal staff have been added
Approved Provider or Person with Management or Control
Representative and department regional contact numbers
are included
Service users’/staff’s primary emergency contacts have
been added
An Incident Management structure has been identified, with
appropriate persons assigned and contact details provided
Responsibilities are clearly defined and back up names
included for each position in the incident management
team
Communications tree detailing process for contacting

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emergency services, staff and primary emergency contacts is

included
Altering or ceasing service, evacuation, lockdown, shelter-
in-place and shelter indoors procedures are in place and
are completed
Localised emergency response procedures have been
developed for specific emergencies in-line with the
hazards/threat identified in the risk assessment
The area map has:
– two evacuation assembly areas on-site
– external evacuation routes
– surrounding streets and safe exit points marked
– emergency services access points marked
The evacuation diagram has:
– a pictorial diagram of the floor or area (at least 200mm
x 150mm in size, A3)
– a title, for example EVACUATION DIAGRAM
– the ‘YOU ARE HERE’ location
– green designated exits
– red marked hose reels
– red marked hydrants
– red marked extinguishers
– designated shelter-in-place locations
– plan validation date
– location of primary and secondary assembly areas
– a legend
Final check completed by:
Date:

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