Appendix F: Sample Emergency Self-Assessment Form
Sample Emergency Self-Assessment Form[1]
| QUESTION | YES | NO |
| Have you done an assessment of the types of emergencies your early childcare education program could experience based on your geographic region? | | |
| Has your early childcare education program developed specific procedures for preparedness, response, and recovery for each type of emergency indicated as a possibility, including how to be informed and how to communicate? | | |
| Does your plan account for practicing and revising your emergency response? | | |
| Do you have a list of emergency contact information for first responders that is visible in your facility | | |
| Do you have updated emergency contact information for each child in your early childcare education program? | | |
| Do you have an emergency kit that is updated monthly and has enough supplies to last for up to 72 hours, including emergency contact information for each child in your early childcare education program and daily attendance sheets? | | |
| Does your program have plans in place to train children, families, and staff (if applicable) about emergency-preparedness plans and procedures? | | |
| Does your plan address continuation of services for children and families? | | |
| Does your plan include how to address the mental health and emotional needs of children, families, and staff (if applicable) before, during, and after an emergency? | | |
| Plans to address any questions that receive a NO rating:
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[1] Emergency Preparedness Manual for Early Childhood Programs by the National Center on Early Childhood Health and Wellness is in the public domain
