Wokingham District Council

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Appendix 3
PERSONAL EMERGENCY EVACUATION PLAN (PEEP)
A Personal Evacuation Plan must be completed for all staff who believe
they will need assistance in evacuating their place of work in event of an
emergency. The process starts with a ’review’ of the individual’s needs.
Then the member of staff and their manager must complete the Plan to
ensure that evacuation can be safely achieved. Copies of both forms are
attached.
Aim
A Personal Emergency Evacuation Plan (known as a PEEP) provides
people who may need assistance evacuating their place of work with
information and a method to manage their escape. It is also essential for
those assisting with the evacuation so they have appropriate information,
instruction and training.
Why this Plan is important?
As your employer Salford City Council has a legal responsibility to ensure
your health and safety at work including implementing effective
arrangements for access and emergency evacuation for staff and visitors.
By completing this Plan you and your manager will be able to establish any
particular requirements that you may have to enable you to safely evacuate
the building.
Who completes the Plan?
If having completed the Evacuation Review both you and your manager
have identified specific requirements for assistance to enable you to
respond to a fire alarm and evacuate the building to a final exit, then please
go on to complete the Personal Emergency Evacuation Plan.
You and your manager should complete this Plan together. Both of you
should read the local emergency evacuation policies before filling it in, and
be satisfied that all aspects of a personal evacuation procedure have been
covered before the PEEP is finalised.
You may wish to consult with your Area Control Officer and Health and
Safety advisor in completing the Plan.
Please note that some questions may be duplicated between the
Evacuation Review and the Evacuation Plan. Duplication is necessary as
these documents may be separated. All Information will only be used on a
‘need-to-know’ basis.
What happens once the form is completed?
Once developed the PEEP will identify your intended means of evacuating
the building(s) in which you work in the event of an emergency or practice
drill. Depending on the job role involved, the PEEP’s can be amended to
include other buildings that you work from.
A copy of the Plan must be lodged with your local Search Officer and Area
Control Officer.
EVACUATION REVIEW
Name:
Tel:
Job Title:
Location:
Section:
Division:
Directorate:
Description of duties:
Managers Name:
Tel:
A: Employee Location
Building:
Floor:
Room No:
B: Evacuation Details
1.
If your job takes you to more than one location in the building in which you are
based please describe these areas.
Continue on a separate sheet if required
2. If your job takes you to different buildings not listed above please list these buildings.
Continue on a separate sheet if required
3. Do you need further information to improve your awareness of the emergency
evacuation procedures that operate in the buildings in which you work?
Building name
Yes




No




4. Do you require a written emergency evacuation procedure?
Yes:

No:

5. Do you require the emergency evacuation procedures to be provided in an alternative
format e.g. BSL, Braille, tape, large print etc?
Yes:

No:

6. Do you have any difficulties reading and identifying the signs that mark the
emergency exits and evacuation routes to the emergency exits?
Yes:

No:

Don’t know:

7. Do you have any difficulties hearing the fire alarm(s) provided in your place(s) of
work?
Yes:

No:

Don’t know:

8. Would you experience ANY problems raising the alarm if you discovered a fire?
Yes:

No:

Don’t know:

9. Has anyone agreed to assist you to evacuate in an emergency?
Yes:

No:

Don’t know:

10.
If yes to question 9, give the name(s) and their location(s) below:
Name
Location
Extension
11. Is the arrangement with your assistant(s) informal i.e. not included in any written
plan?
Yes:

No:

Don’t know:

12. Are you likely to experience problems independently travelling to the nearest
emergency exit at a safe speed?
Yes:

No:

Don’t know:

13. Do you find the stairs difficult to use?
Yes:

No:

Don’t know:

No:

Don’t know:

14. Are you a wheelchair user?
Yes:

15. If you are a wheelchair user, are you able to transfer from a wheelchair by yourself?
Yes:

No:

Don’t know:

16. General Comments (to include any relevant information not already identified above)
If you have ticked ‘YES’ to any of the above questions, complete the Personal
Emergency Evacuation Plan.
17. Do you work outside usual flexitime hours at your usual place of work?
(7.00 a.m. to 7.00 p.m.)
Regularly

If yes please give details below.
Sometimes

Never

PERSONAL EMERGENCY EVACUATION PLAN
This form should be completed for any employee who requires assistance with ANY
aspect of emergency evacuation. The plan should include assistance required from the
point of raising the alarm to passing through the final exit of the building.
A completed form should be held by:
 Employee
 Employee’s line manager
 Search Officers and Area Control Officers (for each building identified)
 The Head of HR (confidentially held central record for inspection purposes)
Note: This plan must be reviewed on an annual basis or when a change in
circumstance (of the building or employee) occurs or is anticipated.
This Plan is for:
Tel:
Job Title:
Location:
Section:
Division:
Directorate:
Description of duties:
Managers Name:
Date completed:
Tel:
Date reviewed:
A: Alarm System
1. I am able/unable to raise the alarm (delete as appropriate).
If unable to raise the alarm independently please detail alternative procedures agreed
2. I am informed of an emergency evacuation by:
existing alarm system: 
vibrating pager device: 
visual alarm system: 
other: (please specify) 
B: Evacuation Procedure (step by step account starting when alarm raised and
finishing on final exit)
C: Designated Assistance (details of all persons designated to assist in executing
evacuation plan and the nature of assistance to be provided by each)
D: Method of Assistance (e.g. transfer procedures, methods of guidance)
E: Equipment provided (details of all equipment needed to execute the plan and its location)
F: Training on use of equipment
Date
Comments
G: Safe route(s) (description of the primary & secondary escape routes)
N.B. A copy of the building plan with route clearly marked to be attached. (a plan of your building
can be obtained from Property Information, Ext: 6104 or e-mail: [email protected]
An alternate exit route should also be shown. (i.e. two routes).
Has the route been travelled by employee & manager?
Have copies of the exit route(s) been attached?
Has the equipment detailed above been tried & tested?
Has the PEEP been completed to full satisfaction?
If No to any of the above please explain below.
Yes
No








I am aware of the emergency evacuation procedures and believe them to be
appropriate to the requirements identified above.
Employee signature:
Date:
Employee name:
Managers signature:
Date:
Managers name:
This plan must be reviewed on an annual basis or when a change in circumstance (of
the building or employee) occurs or is anticipated, which could affect the plan. The
review should determine what changes have occurred and what impact these changes
have on enabling the person to escape in an emergency.
Copies of this form should be held by:
 The person it has been prepared for
 Line Manager (if applicable)
 Search Officers for the building(s) they are usually based in
 Area Control Officers for the building(s) they are usually based in
 The Head of HR (confidentially held central record for inspection purposes)
Date of next review:
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