| Fire: | 911 Name: _________________________________ |
| Police: | 911 Address: _________________________________ |
| Paramedic: | 911 Phone #: _________________________________ |
| Non-Emergency Police: | (______) ________-____________ |
| Electric Utility Company: | (______) ________-____________ |
| Primary Hospital: | (______) ________-____________ |
| Local Hospital: | (______) ________-____________ |
| Primary Physician: | (______) ________-____________ |
| Equipment Company: | (______) ________-____________ |
| Emergency Contact: | (______) ________-____________ |
| Mom Work | (______) ________-____________ |
| Mom Cell | (______) ________-____________ |
| Dad Work | (______) ________-____________ |
| Dad Cell | (______) ________-____________ |
| Other 1: | (______) ________-____________ Who: ____________ |
| Other 2: | (______) ________-____________ Who: ____________ |
| ☐ Front Door | ☐ Back Door | ☐ Side Door |
| ☐ Garage Door | ☐ Window | ☐ Other: ___________________ |
Meeting point after evacuation: ______________________________
Location of fire extinguisher: ________________________________
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