Fillable Printable Emergency Action Plan Sample
Fillable Printable Emergency Action Plan Sample
Emergency Action Plan Sample
Emergency Action Plan
________________________
Team Name
Head Coach: _____________________________ Phone: _______________________
Assistant Coach: __________________________ Phone: _______________________
Park Supervisor: __________________________ Phone: _______________________
Director of Athletics: ______________________ _ Phone: _______________________
Emergency Medical Services Phone Number: _____________________
EMS Protocol
When you call EMS, provide your name and title or position, current address, telephone number; number
of individuals injured; condition of injured; first aid treatment; specific directions; other information as
requested.
Scene control: Limit scene to first aid providers and move bystanders away from area.
Facility Addresses
Practice Facility:______________________________________
Competition Facility: __________________________________
Strength and Conditioning Venue: _________________________
Outdoor Facility: _______________________________________
Indoor Facility: ________________________________________
Hospital Name: _____________________________________________________
Emergency Room Phone Number:______________________________________
Hospital Directions
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Emergency Task Assignments Assigned to
Immediate care of the injured or ill participant ______________________________
Emergency equipment retrieval ______________________________
Call EMS ______________________________
Unlock and open doors for EMS ______________________________
Flag down EMS and direct to scene ______________________________
__________________________________ ______________________________
__________________________________ ______________________________
__________________________________ ______________________________
__________________________________ ______________________________
__________________________________ ______________________________
t eam r oster with Emergency c ontact and
I
nformation
For emergency use only, do not publish this information for distribution.
Athlete Emergency # Emergency Contact Special Condition
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