Emergency disaster plan for adult day programs, adult residential ... - cdss ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name and address of your facility in the designated fields at the top of the form.
3. In Section I, assign staff members specific emergency roles. Fill in their names next to each title and assignment, ensuring clarity on responsibilities during an emergency.
4. Proceed to Section II to list important emergency contacts. Include phone numbers for local fire services, police, hospitals, and other relevant agencies.
5. In Section III, indicate facility exit locations using a copy of your facility sketch. Number each exit clearly for easy identification.
6. For Section IV, provide details of temporary relocation sites if available. Ensure you have permission from property owners where applicable.
7. Complete Sections V through VIII by detailing utility shut-off locations, first aid kit placement, and affirmation statement with your signature and date.

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