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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