This form is to be used to account for individuals during an emergency. These forms Purpose should be pre-populated with the names of faculty, staff, or employees assigned to work in an area or a floor. These forms should be posted in a conspicuous place where they can be removed by the Floor Safety Monitor or area supervisor as staff evacuate. The list of names should be used to verify all employees have made it to the designated assembly or shelter area, or if their location is known. Completed accountability forms shall be provided to the Assembly Area Monitor(s) so they can inform first responders of unaccounted for personnel. NOTE: A class roster can be used by faculty as the basis for performing an accountability check in place of this form. NOTE: Assembly Area Monitor(s) should consult with each other to verify unaccounted for personnel are not in other Assembly/Shelter Area(s) before reporting them as unaccounted for to emergency responders. Building Floor/Area Date Time Completed By: (Completed at time of (Completed at time of (Completed at time of emergency) emergency) emergency) INSERT INSERT BLDG NAME FLOOR/AREA Person Status (Completed at time of emergency) □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME □ □ □ Present Missing Offsite INSERT NAME NOTE: If needed additional Persons can be to this list by adding rows to the table
Purpose This form is to be used to account for individuals during an emergency. These forms should be pre-populated with the names of faculty, staff, or employees assigned to work in an area or a floor. These forms should be posted in a conspicuous place where they can be removed by the Floor Safety Monitor or area supervisor as staff evacuate. The list of names should be used to verify all employees have made it to the designated assembly or shelter area, or if their location is known. Completed accountability forms shall be provided to the Assembly Area Monitor(s) so they can inform first responders of unaccounted for personnel. NOTE: A class roster can be used by faculty as the basis for performing an accountability check in place of this form. NOTE: Assembly Area Monitor(s) should consult with each other to verify unaccounted for personnel are not in other Assembly/Shelter Area(s) before reporting them as unaccounted for to emergency responders. Building Floor/Area Date (Completed at time of emergency) Time (Completed at time of emergency) Completed By: (Completed at time of emergency) INSERT BLDG NAME INSERT FLOOR/AREA Person Status (Completed at time of emergency) INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ INSERT NAME Present □ Missing □ Offsite □ NOTE: If needed additional Persons can be to this list by adding rows to the table
Attachment%20G%20Accountability%20Form%20Template.docx