Emergency
Management Plan
Workbook
DEPARTMENT/UNIT:
PROJECT LOCATION:
PROJECT LEAD:
DATE:
Table of Contents
Introduction ........................................................................................ Error! Bookmark not defined.
Statement of Purpose...................................................................................Error! Bookmark not defined.
Definitions: ......................................................................................................Error! Bookmark not defined.
I. Emergency Response Preparation .......................................... Error! Bookmark not defined.
A. Contact Information ................................................................................Error! Bookmark not defined.
1. On-Site Management Team ......................................................................................... Error! Bookmark not defined.
2. Institute/University Partner....................................................................................... Error! Bookmark not defined.
3. Local First Responders .................................................................................................. Error! Bookmark not defined.
4. US Embassy/Consulate Information ....................................................................... Error! Bookmark not defined.
5. Boston Contact Information........................................................................................ Error! Bookmark not defined.
6. Health and Travel Insurance ...................................................................................... Error! Bookmark not defined.
7. Health Services, Physicians & Hospitals ................................................................ Error! Bookmark not defined.
8. Other Useful Numbers ................................................................................................... Error! Bookmark not defined.
B. Itineraries and Travel Arrangements ...............................................Error! Bookmark not defined.
1. Emergency Contact information ............................................................................... Error! Bookmark not defined.
2. Additional Contacts......................................................................................................... Error! Bookmark not defined.
C. Responsible Personnel: Emergency Management Team and AssignmentsError! Bookmark
not defined.
D. Emergency Communication Protocol ...............................................Error! Bookmark not defined.
1. The Phone Tree................................................................................................................. Error! Bookmark not defined.
2. Field Communication Resources .............................................................................. Error! Bookmark not defined.
3. Essential Emergency Communication .................................................................... Error! Bookmark not defined.
E. Fire Safety Plan ..........................................................................................Error! Bookmark not defined.
F. Providers and Vendors ...........................................................................Error! Bookmark not defined.
II. Evacuation Preparation ............................................................. Error! Bookmark not defined.
A. Premises Evacuation Plan .....................................................................Error! Bookmark not defined.
B. Assembly Points ........................................................................................Error! Bookmark not defined.
C. Shelter-In-Place .........................................................................................Error! Bookmark not defined.
D. Large-Scale Evacuation Plan ................................................................Error! Bookmark not defined.
III. Emergency Response: Actions .............................................. Error! Bookmark not defined.
A. General and Essential Actions .............................................................Error! Bookmark not defined.
B. Other Contingency Plans .......................................................................Error! Bookmark not defined.
IV. Appendix A: Emergency Response Flow at Boston University ... Error! Bookmark not
defined.
V. Appendix B: Filing Incident Reports ..................................... Error! Bookmark not defined.
VI. Attachment #1: Incident Log .................................................. Error! Bookmark not defined.
VII. Attachment #2: Incident Report Form .............................. Error! Bookmark not defined.
Boston University Global Programs
Updated: 2/8/16
page 2
Introduction
Regardless of the size of the program, Boston University activities abroad should have an Emergency
Management Plan (EMP) detailing the critical information needed in effective emergency planning and
response. The essential elements that comprise your EMP are:
1. Emergency Response Preparation;
2. Evacuation Preparation;
3. Emergency Response Actions.
You can use this workbook to assemble these elements quickly, allow you to refer to them easily, and
allow your activity’s emergency management team in Boston access to the same information.
Additionally, your EMP will provide the basis for the training of all participants. The few minutes it takes
to review preparation and procedures can prove invaluable in an emergency.
For more information on resources to help you complete the workbook, on emergency planning and on
health, safety and security abroad in general, visit Global Programs’ Health, Safety, and Security
webpage.
Statement of Purpose
The purpose of this Emergency Management Plan (EMP) is to ensure the safety and well-being of
participants in the [
] Program, located in
the town/city and country of [
].
The EMP contained on the following pages follows the Global Program guidelines for Developing an
Emergency Plan. It provides the on-site Project Lead and staff and administrative offices at Boston
University with detailed emergency contact information, assembly and evacuation information, and
general instructions on how to respond in a crisis situation, with role assignments.
Definitions:


Emergency Management Team (EMT): group of individuals identified by an organization to lead
in decision making and task assignments during a time of crisis or emergency.
o Typically composed of senior leadership on-site and at Boston University.
Director/Project Lead: The most senior or otherwise responsible authority on-site.
Boston University Global Programs
Updated: 2/8/16
page 3







Unit Contact: The designated person in your office or academic unit in Boston who would serve
as the first and primary contact in the event of trouble abroad.
First Responders: Name for civil servants (fire, police, trauma units etc.), that are called during
an emergency to provide immediate support to victims.
Incident Commander (IC): the head of the EMT and the most senior person on site when an
incident occurs.
o Takes the lead in seeing to the immediate needs of the involved individuals, contacting
first responders and securing the area.
o When a more senior person arrives, the role of IC is relinquished to that individual for
further action.
Communications Manager: Person designated to speak to authorities, home schools, parents,
un-involved students, and/or media.
o Some of this responsibility may be shared with Boston.
Incident Log: Detailed list of actions taken during the course of an emergency that will assist in
reconstructing what happened, who was responsible for each step in the incident resolution,
and determining and tracking next steps.
o When a large team is available and has been assembled to respond to a crisis, the IC
may appoint someone else to maintain the Incident Log, in order to manage other
responsibilities. Close communication between the two is required.
Incident Recorder: Person charged with the efficient and accurate recording of the incident,
including day, time, issues, requests, actions, decisions, strategies, persons involved and other
relevant information.
o Provides copies of the log, as needed, to the IC or other authorized personnel
o Stays the course- does not get involved in other jobs, in order to focus on capturing all
essential information, actions and requests.
Incident Report Form (IRF): Description of the event, summary of the information contained in
the Incident Logs, record of communications, interviews with those involved, reports from
authorities, situation analysis and recommendations for future actions
Boston University Global Programs
Updated: 2/8/16
page 4
I. Emergency Response Preparation
This section will comprise the information you collected on local resources, detailed itinerary and
contact information for participants, a detailed communication protocol, program-specific emergency
response procedures and fire safety protocols.
A. Contact Information
1. On-Site Management Team
Program Director/Project Lead
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Second Contact
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Third Contact
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
2. Institute/University Partner
Emergency/security or hotline number:
Institute/University Partner:
Contact Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Second Contact
Name
Boston University Global Programs
Updated: 2/8/16
page 5
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Third Contact
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
3. Local First Responders
Primary Emergency Service
Number equivalent to 911 in US
Police Station
Phone Number
Address
Fire Station
Phone Number
Address
Ambulance Service
Phone Number
Counseling or Mental Health
Phone Number
4. US Embassy/Consulate Information
US Citizens 24/7 Emergency Services
Number:
Embassy/Consulate Street Address:
Nearest Public Transportation Stop:
Website:
5. Boston Contact Information
Primary Contact (Unit)
Name
Title/Position
Boston University Global Programs
Updated: 2/8/16
page 6
Phone (Day)
Phone (After-Hours)
Email address(es)
Second Contact
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Third Contact
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Boston University Global Programs
Name
Title/Position
Phone (Day)
Phone (After-Hours)
Email address(es)
Joe Finkhouse,
Associate Director, Health, Safety & Security
1-617-358-6350
1-617-777-3122
finkhous@bu.edu
6. Health and Travel Insurance
Medical Insurance
Provider
Policy Number(s)
Domestic Phone Number(s)
International Phone Number(s)
Email Address(es)
Travel Assistance and Emergency Evacuation
Provider
Policy Number(s)
Domestic Phone Number(s)
International Phone Number(s)
Email Address(es)
Boston University Global Programs
Updated: 2/8/16
page 7
7. Health Services, Physicians & Hospitals
Physicians: List the name and contact details of the physician(s) and dentist(s) associated with care for
the program participants. If none, enter the name and contact details for the nearest or most likely to
be used in an emergency.
Physician #1
Name
Specialty or Type of practice
Address
Phone
Office Hours
Physician #2
Name
Specialty or Type of practice
Address
Phone
Office Hours
Health Facility/Hospital: List the name and contact details of the health facility or hospital associated
with care for the program participants. If none, enter the name and contact details for the nearest or
most likely to be used in an emergency.
Hospital or Clinic #1
Name
Address
Phone
Hospital or Clinic #2
Name
Address
Phone
Health Services- Mental Health: List the name and contact details of the mental health specialist and
facility nearest to the program site or that is most likely to be used in an emergency.
Mental Health Specialist #1
Name
Address
Phone
Office Hours
Mental Health Specialist #2
Name
Boston University Global Programs
Updated: 2/8/16
page 8
Address
Phone
Office Hours
Mental Health Facility #1
Name
Address
Phone
Mental Health Facility #2
Name
Address
Phone
Health Services- Pharmacies: List two nearby pharmacies that would most likely be used in an
emergency. Add more if needed.
Pharmacy #1
Name
Address
Phone
Hours of Operation
Pharmacy #2
Name
Address
Phone
Hours of Operation
8. Other Useful Numbers
Local Bank or Wire Transfer Office (for receipt of emergency funds)
Name
Phone (Day)
Phone (After-Hours)
Contact Name
Normal Business Hours
Street Address(es)
Local transportation supplier
Name of Organization
Phone (Day)
Phone (After-Hours)
Contact Name
Normal Business Hours
Street Address(es)
Email Address(es)
Boston University Global Programs
Updated: 2/8/16
page 9
Local Supplier
Name of Organization
Phone (Day)
Phone (After-Hours)
Contact Name
Normal Business Hours
Street Address(es)
Email Address(es)
Local Supplier
Name of Organization
Phone (Day)
Phone (After-Hours)
Contact Name
Normal Business Hours
Street Address(es)
Email Address(es)
Local Supplier
Name of Organization
Phone (Day)
Phone (After-Hours)
Contact Name
Normal Business Hours
Street Address(es)
Email Address(es)
B. Itineraries and Travel Arrangements
Detailed travel and contact information for each traveler. Note: For larger groups, please copy and
paste the following tables for each traveler or attach an Excel spreadsheet with the information below
for all travelers.
Name of Traveler
BU Affiliation
Destination and Purpose of Trip
Departure Date/Time
Departure Flight/Train Number
Return Date/Time
Return Flight/Train Number
1. Emergency Contact information
Emergency Contact Person Name
Best Method of Contact
Relationship to You
Boston University Global Programs
Updated: 2/8/16
page 10
Email
Phone
Address
2. Additional Contacts
Name of Provider
Phone
Email
Travel Agent
Airline
Railroad
Car Rental Agency
Accommodations
Other
C. Responsible Personnel: Emergency Management Team and Assignments
The establishment of an Emergency Management Team (EMT) provides a clear chain of command and
will reduce confusion and uncertainty during an emergency. The EMT should participate fully in the
creation of the EMP for their program. The EMT must be familiar with the documents contained in this
workbook, ensure it is maintained, and conduct periodic drills on the plan to ensure its viability.
The EMT may consist of more positions than those shown here. If that is the case, list each additional
role and position holder at the end of this section. In a small staff situation, one person may be required
to assume more than one role. Those selected to fill these roles should be:



Capable and competent decision makers,
Able to pass out clear and concise directions, and
Physically present most of the time.
Incident Commander: the Director/Project lead or most senior person available on-site at the time of
the emergency situation becomes the Incident Commander (IC). The IC directs local efforts and is the
primary contact person for both local authorities and Boston University. The IC position is relinquished
when a more senior person arrives to assume command or when the shift is over.
Incident Commanders will be assigned in the following order:
1.
2.
3.
4.
Name:
Name:
Name:
Name:
Boston University Global Programs
Phone:
Phone:
Phone:
Phone:
Updated: 2/8/16
page 11
Communication Manager: the IC may appoint someone to manage communications or choose to do so
him/herself. Only the Communications Manager should speak to authorities, program affiliates,
parents, un-involved students or the press.
Communications Managers will be assigned in the following order:
1.
2.
3.
4.
Name:
Name:
Name:
Name:
Phone:
Phone:
Phone:
Phone:
Incident Log Recorder (ILR): the IC may appoint someone to maintain the Incident Log. The ILR is not
involved in decision making, unless asked to participate. Criteria for appointment include detail
mindedness, the ability to work in a confidential manner and proficiency at note-taking.
The ILR will be assigned in the following order:
1.
2.
3.
Name:
Name:
Name:
Phone:
Phone:
Phone:
Additional EMT roles:
Boston University Global Programs
Updated: 2/8/16
page 12
D. Emergency Communication Protocol
1. The Phone Tree
At the start of the program each Director should collect the participants’ local contact information and
create a phone tree in order to establish quick communication with everyone in the program, should the
need arise. The phone tree directs the flow of information from a reliable source (usually the
Director/Project Lead) to all personnel on-site.
The phone tree is activated by order of the program site Director/Project Lead, or Incident Commander.
In the event of an incident requiring notification to all members of the program, the following procedure
will be followed:






The tree is activated with instructions on exactly what information and/or procedures are to be
communicated by the caller.
Callers contact all participants to provide the information as instructed and, if necessary,
ascertain their current location and safety status.
Should any assigned caller be unreachable, the person above him or her in the tree will assume
the missing person’s responsibility and call list.
Once every participant has been contacted, a designated person will contact the Director or IC,
relaying location information and confirming that all were contacted.
Every effort will be made to contact participants via email, text message, tweet, and Facebook in
addition to calling.
An Excel version of the Phone Tree Template can be found at:
http://www.bu.edu/globalprograms/files/2013/08/Phone-Tree-Form_Global-Programs.xlsx
Phone Tree Template
Caller
Last
Name
First
Name
UID
Email(s)
Address
Postal
Code
City
Landline
Local Cell
Phone
Director/IC
Director/IC
Director/IC
Participant A
Participant B
Participant C
Participant D
Participant E
Participant F
Boston University Global Programs
Updated: 2/8/16
page 13
2. Field Communication Resources
Central Mobile/Satellite
Phone Number
Media to Be Used
Facebook Page
Twitter Handle
Other (Describe)
Local Internet Access Point #1
Business Name
Phone
Location Description
Local Internet Access Point #2
Business Name
Phone
Location Description
Please complete the following:

Describe what to do if communication fails:

Detail what instructions will be given to students (if applicable) about contacting the program
office, each other, and their parents:

Detail any other site-specific communication preparations:
Boston University Global Programs
Updated: 2/8/16
page 14
3. Essential Emergency Communication
Once the immediate needs of those directly involved have been met, the following basic procedure
applies:
1. Contact all program participants.
a. Confirm all are safe and accounted for within one hour or as soon as possible.
b. Determine and record their present locations.
c. Instruct them to follow the program’s emergency plans, specifically where to go/not go
and what they should do/not do.
2. Contact your Emergency Travel Assistance Provider
a. ACE (faculty and staff) or CISI or OnCall (students).
3. Notify Designated Unit Contact in Boston
a. Inform on-site and/or Boston contact of the nature of the crisis, your location, the
location of students and staff members, and all relevant details available.
b. If you cannot reach your designated contact number within fifteen minutes, call their
designated backup person.
c. If you cannot locate either person, please call BU Global Programs, Associate Director,
Health, Safety and Security.
4. Update the University continuously throughout the crisis and regularly in the following hours
and days regarding the condition, safety, and location of all personnel
5. Ensure that all actions and communications are logged and submitted to your Boston unit and
Global Programs using the standard Incident Report Form (see Appendix B).
E. Fire Safety Plan
Provide plans for program and housing facilities.

In-Case-of-Fire Procedures:

Location and inspection schedules for:
o Fire extinguishers
o Smoke detectors
o Emergency exits

Schedule for Training and Drills:
F. Providers and Vendors
Attach relevant emergency plans from:
 University partners

Housing providers
 Transportation providers, including emergency transportation/evacuation providers.
Boston University Global Programs
Updated: 2/8/16
page 15
II. Evacuation Preparation
In rare instances, evacuation may become necessary due to environmental, political, industrial, and/or
health concerns. Therefore, it is imperative that you develop simple, easy-to-follow protocols and
ensure that all participants are aware of the procedure for responding to such an event.
A. Premises Evacuation Plan
If there is more than one building in the program site, complete this information for each building.
Where buildings are leased, consult with the building landlord on emergency evacuation routes and
floor plans and to coordinate fire drills at the beginning of each semester.
This is the Evacuation Plan for:
(If there is more than one building in the program site, this page should be filled out for each building.)
Notification of the need to evacuate will be by the following means:
Teams of two persons each should be assigned to ensure everyone has left the building. The following
teams have been created, with responsibility for the areas shown in the table below. (!)Note: The
number of teams and area of assignment will vary according to the size of the facility.
Team 1/Person 1
Team 1/Person 2
Assignment
Team 2/Person 1
Team 2/Person 2
Assignment
Team 3/Person 1
Team 3/Person 2
Assignment
The following person is responsible to ensure everyone is accounted for at each assembly point.
Name
Responsible for: (assembly point or department)
Boston University Global Programs
Updated: 2/8/16
page 16
B. Assembly Points
The assembly point is to be used in the event of an evacuation of the premises due to smoke, fire or by
order of the authorities. It will also be used in the event of an area-wide catastrophe that renders the
facility unusable and during which telephone land lines are down and cell service is disrupted.
The designated place will have these characteristics:





Far enough away from the facility being evacuated to be safe, but close enough to be
conveniently reached on foot
A public space that is easily recognized by participants
Contain sufficient room for all students, faculty and staff to gather comfortably, without
impeding traffic or obstructing emergency response vehicle pathways
Well-lit at night
Close to food, water, restrooms and transportation
Examples: Hotel lobby, train station, public park with restaurants nearby
The primary assembly point for this site is:
Directions to the primary Assembly Point:
The secondary assembly point for this site is:
Directions to the secondary Assembly Point:
Boston University Global Programs
Updated: 2/8/16
page 17
C. Shelter-In-Place
In the event of environmental emergencies (e.g., gas leak, external chemical fire) or natural hazards
(e.g., sudden storm, tornado) or other major events, authorized authorities or program staff may
require students and staff to stay indoors for their own safety, rather than evacuate. A shelter-in-place
command can last from a few minutes to a few days, such as in the event of a civic emergency.
On notification of the order to Shelter-in-Place, anyone who is in the building must remain there. All
students, faculty and visitors will assemble at the location(s) listed below.
During large-scale events, such as incidents of political unrest or natural disasters, it is often safer to
shelter–in-place than try to evacuate. Decisions should be taken with that in mind.
Sheltering location(s) is/are
Sheltering location(s) is/are
While Sheltering-in-Place:








Doors should be locked.
In the case of a storm, close blinds and curtains to protect against flying objects that may hit the
building.
Remain in the shelter location until the all-clear has been sounded and normal operations resume.
Students should call their parents to inform them of their safety, is possible.
Staff will contact participants not on the premises and advise them to stay away.
If you are off-site and are advised to stay away, please do so.
Staff will contact you again when the situation has cleared.
If more than one shelter location is needed, each room will have a responsible person assigned to
distribute supplies, record names and communicate with Boston, as well as their counterpart in
other shelter locations.
D. Large-Scale Evacuation Plan
The decision to evacuate a program location is normally made in consultation with Boston University
unless the Director/Project Lead determines that participants are in immediate danger. Even so, it is
often safer to shelter in place than to move. Therefore, this decision cannot be taken lightly.
If conditions suggest that that an evacuation may be necessary, please inform your designated unit
contact immediately. They will then inform the Global Programs Associate Director for Health, Safety
and Security, who will convene those individuals necessary to authorize such an event.
Boston University Global Programs
Updated: 2/8/16
page 18
In the spaces below, describe your plans for what to do if an evacuation from your location were
necessary.

Triggers for Evacuation (e.g., major terrorist threat, threat of pandemic disease, natural
disaster, U.S. State Department warning):

Emergency Transportation (method, contact information, procedure):

Evacuation destination, including plans for accommodation and food/drink:

Plans for continuing program activities, if feasible:
Boston University Global Programs
Updated: 2/8/16
page 19
III. Emergency Response: Actions
A. General and Essential Actions
Despite the varying degrees of emergency that will be encountered, there are basic steps to be taken
under all circumstances, as follows:
1. Meet the immediate needs of participants.
a. Contact police, ambulance, or other first responders, as necessary.
b. Stay with individuals affected until help comes or the situation clarifies.
c. Only move participants if it is deemed too dangerous to shelter–in-- place.
2. Assess the situation and any threats or dangers posed to participants.
a. Specific threats or dangers they face
b. Immediate steps that can and should be taken to help reduce the harm, danger, or
threat level
c. Whether they are safer remaining in their present location(s) or, if relocation is
necessary, where they should go.
3. Contact all program participants.
a. Confirm all are safe and accounted for within one hour or as soon as possible.
b. Determine and record their present locations.
c. Instruct them to follow the program’s emergency plans, specifically where to go/not
go and what they should do/not do.
4. Contact your Emergency Travel Assistance Provider
a. ACE (faculty and staff) or CISI or OnCall (students).
5. Notify Designated Unit Contact
a. Inform on-site and/or Boston contact of the nature of the crisis, your location, the
location of participants, and all other relevant details available.
b. If you cannot reach your designated contact number within fifteen minutes, call
their designated backup person.
c. If you cannot locate either person, please call BU Global Programs, Associate
Director, Health, Safety and Security.
6. Update the University continuously throughout the crisis and regularly in the following
hours and days regarding the condition, safety, and location of all personnel
7. Maintain a written log of the crisis
a. Include specific dates, times, actions taken, and other relevant details, beginning
with your first notice of the crisis and continuing through its resolution.
b. Include copies of all emails.
8. Submit an incident report to your unit and Global Programs.
B. Other Contingency Plans
Detail any other site-specific response plans relating to the conditions of your program,
location, or facilities:
Boston University Global Programs
Updated: 2/8/16
page 20
Appendix A: Emergency Response Flow at Boston University
Generally, emergency response and resolution will follow this process:
Emergency or Other Incident
Director/Project Lead
becomes aware of incident or
issue affecting an individual or
program.
On-Site Emergency Response


Director/Project Lead or Emergency
Management Team meets immediate needs of
participants
Director/Project Lead carries out next steps of
the activity’s emergency plan.
Resolve On-Site

Director/Project Lead
resolves incidents which
can be managed successfully
on-site, and reports to
Global Programs.
Refer to Boston, for Reporting
Only



Refer to Boston

Boston Emergency Response

Director/Project Lead
submits incident report to
sponsoring Unit and Global
Programs.
Global Programs notifies
VP\AP Global Programs and
other relevant offices
Global Programs schedules
review and follow-up





Boston University Global Programs
Director/Project Lead refers
actual or potential
emergencies which cannot be
resolved on site to
sponsoring unit and Global
Programs.
Updated: 2/8/16
Sponsoring unit and/or Global Programs
Associate Director informs VP/AP Global
Programs and other relevant offices.
Sponsoring unit and Global Programs
coordinate Unit and University response to
emergency,
Crisis Management Team convened for issues
requiring a coordinated, multi-office response,
or which present a risk to University operations
or reputation.
In all cases communication is maintained with
Director/Project Lead.
Resolve and report to Provost, President.
All involved parties review and follow-up.
page 21
Appendix B: Filing Incident Reports
Emergencies, illnesses, crimes and other incidents affecting students, faculty, staff, facilities, or the
surrounding community must be reported to Boston using a standard Incident Report Form (IRF).
1. The IRF is found at http://www.bu.edu/globalprograms/files/2013/07/Incident-ReportForm_Workbook_GP-07192013.doc and as an attachment at the end of this workbook.
2. The IRF is filled out by the in-country Director or by the Incident Recorder and signed by the
Director. It is used to summarize the incident or emergency action that has occurred.
 In the case of a major emergency, Incident Logs, emails and other forms of
correspondence must be attached as back-up at the time the IRF is submitted.
3. IRF’s should be submitted to the designated unit contact with a copy to the Associate Director,
Health Safety and Security at Global Programs
4. If you are in doubt about whether or not an incident should be reported, the general instruction
is that it is better to over-report than underreport. The following are types of incidents that
must be reported:
 Any report or allegation of a crime involving a student, faculty or staff member
 Any illness or injury requiring emergency treatment or hospitalization.
 Any natural disaster or political event that may affect the program.
 Any incident requiring the use of an emergency travel assistance provider for medical
evacuation or repatriation.
 Any incident which may result in the early departure of a student from the program or
disciplinary action taken by Boston University
 Any incident which may affect the reputation of Boston University or the future
operation of the activity
 Any other incident or situation which the in-country Director, other staff, or student
believes should be brought to the attention of Boston University
Boston University Global Programs
Updated: 2/8/16
page 22
Attachment #1: Incident Log
To be completed by the Incident Commander or assigned Recorder, during an active situation.
Reporting Site
Date of Incident
IC or Recorder
Date of Log
Incident Location
Incident Commander:
Page ________ of
________
Note: ACT means an Action has been taken. REQ means a request has been made to the Emergency Management Team.
ACT/REQ status is either On-Going, Completed or Follow-Up Required.
All other Activity/Details are incident information only or situation reports.
Entry #
ACT/REQ
Activity/Details
Status
Copies of this document are considered to be AS OF the date and time printed or copied.
Boston University Global Programs
Updated: 2/8/16
page 23
Attachment #2: Incident Report Form
All fields must be completed. Please refer to Appendix B for instructions on what to report.
Program Name
Date of Report
Incident Location (please be precise)
Incident Time and Date
Person to whom incident was
reported
A. Name of Individual Affected:
B. Nature of Incident
Check all that apply.
Injury
Illness
Crime
Political event
Natural disaster
Student code violation
Other (specify) _________________________________
C. Actions Taken
Check all that apply.
Visit medical facility
Notify emergency contact
Contact Boston University
Notify local police or other authorities
Move student
Evacuate Student
Fine Student
Other (specify)_____________________
D. Please Attach Brief Narrative Description Detailing:
1.
2.
3.
4.
The Nature of the Incident
The Actions Taken
The Follow-up Actions Taken
A Brief Analysis and Recommendations (e.g., what might we do to prevent this from
happening again?)
E. Please attach your communication log, including relevant emails and other
communications.
Boston University Global Programs
Updated: 2/8/16
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