Personal Emergency Evacuation Plan (PEEP)
The need for a personal emergency evacuation plan should be assessed at initial
induction or enrolment by the responsible person(s) for anyone who may require
assistance to evacuate the premises in an emergency. Occasional visitors who may
require such assistance can be accommodated by the use of a generic emergency
evacuation plan which should form part of the whole premises evacuation plan. It is
important to note that any personal or generic plan will normally be location specific
within a premise and any impromptu room or area change may necessitate reassessment of the plan. Any personal plan should be cross-referenced and
incorporated within any other personal risk assessment or care plan and
arrangements made to share with all involved persons (plan holder, premises
managers, fire wardens, fire brigade etc) as maybe indicated. This form is intended as
a generic guide and may be amended as required to suit departmental needs.
1. Personal Emergency Evacuation Plan for
Name:
(The Plan Holder)
Contact details:
Location / Address
building/floor/room
Department/Team
(if applicable)
Separate plans may be required for multi location working or to accommodate
operational differences caused by shift patterns, if more than one plan per person state
Plan…..of…….
2. Arrangements in the Event of an Evacuation
Alarm/Warning
The Plan Holder will receive warning of an emergency by:
Existing alarm system
Pager device
Visual alarm system
Nominated persons
(name in assistance below)
Other (please specify)
Assistance
Does the Plan Holder require assistance to evacuate safely?
Yes
No
This should be discussed with the plan holder as they may feel that in the event of an emergency they
could make an exceptional effort and escape unaided in a safe manner
The Plan Holder will require assistance from…..people to evacuate safely (state number),
and provision needs to be made to ensure this number of people is available at all
times the Plan Holder is on the premises. It is important that anyone required to
provide assistance understands what is required of them, is provided with appropriate
training and a copy of this plan
Name
Contact details
I understand the duties required of me
Signed
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Name
I understand the duties required of me
Contact details
Signed
I understand the duties required of me
Name
Contact details
Signed
I understand the duties required of me
Name
Contact details
Signed
I understand the duties required of me
Name
Contact details
Signed
I understand the duties required of me
Name
Contact details
Signed
Equipment required (include location)
Evacuation procedure (Step by step from first alarm to outside the building,
including detail of any routes that may be used, a sketch or plan may be attached)
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Plan
Attached
Practice
Practice will depend on the type of escape required. Generally escape plans should be
practiced on a regular basis and at least every six months. Some systems may need
testing more frequently than that, for instance paging systems and other specialist
equipment. All the people involved in the escape plan should take part, however it
may be more appropriate to simulate such procedures as carry-down so as not to
cause any unnecessary risk. Where a person has elected to make an exceptional
effort to get out unaided it would probably not be practical for them to practice,
however timing a short section of the escape will help in establishing how long a full
escape might take. Young persons or people with a learning difficulty may need to
practice their routes for escape more frequently, If so this should be written into their
plan.
Type of test/practice
Frequency
Where records are kept
3. Plan completed by
The plan Holder has been made aware of this plan by appropriate means of
communication and understands what is required in the event of an emergency
Name
Date
Position
Contact
Details
4. Copies of Plan given/sent to:
*as required
Plan Holder
Date
*Carer/Parent/Guardian
Date
*Line Managers/Teachers
/Care Managers
Date
*Assistants/Care
Support workers
Date
Premises Coordinator /
Head Teacher /
Site Manager or
Responsible Person
Date
5. Review Procedure
This Plan will be reviewed every 12 months, or following;
 An evacuation
 Any change in the Plan holder’s ability
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
Any significant change in layout, design, management or use of building or
other operational circumstance which may affect the enactment of the plan
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