Lic 610e 2025

1. Click ‘Get Form’ to open the lic 610e in the editor.
2. Begin by entering the 'Name of Facility' and 'Administrator of Facility' in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the 'Facility Address' including number, street, city, state, and zip code. This helps emergency services locate your facility quickly.
4. Provide contact numbers: telephone, fax, and cell phone. These should be current to ensure effective communication during emergencies.
5. In the 'Assignments During an Emergency' section, list staff assignments clearly. Use the reverse side if more space is needed for additional roles.
6. Complete the 'Emergency Names and Telephone Numbers' section with relevant contacts such as fire services and medical facilities to facilitate quick access during crises.
7. Indicate facility exit locations using a copy of the facility sketch (LIC 999) for clarity on evacuation routes.
8. Document temporary relocation sites if available, ensuring you have permission from property owners where applicable.
9. Identify utility shut-off locations on your facility sketch to prepare for potential emergencies involving utilities.
10. Finally, complete the affirmation statement by signing and dating it to confirm your responsibility for this emergency plan.

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