Emergency Plan Manual

TABLE TOP EXERCISE  (Agency’s Emergency Plan) Date of exercise: ___________ Objective of exercise : Participant : Plan Review Agency’s Emergency Plan (EP) completed on ____________ EP reviewed by Agency’s Executive/key Staff, Board of Director, PAC, (including structure, content and objectives of the plan) Submitted to DOH county(ies) for review and approval DOH response received by Agency Plan updated as required per Local, County, State, Accreditation and Federal regulation and standard as applicable Paper-based to hands-on. Key staff identified, responsibilities assigned, explained, understood. Activation responsibilities and roles explained. Disaster Mitigation discussed, including staff, patients, clients and families. Educational needs discussed (prior, during and after emergencies). The education of patients regarding their responsibility for their medication, supplies and equipment list or other emergency preparedness information as needed Emergency patient’s classification discussed, approved. Special need shelter registration discussed (choice of last resort), Emergency Plan form, Registration form discussed. The procedures on how the home health agency staff in charge of emergency plan implementation will receive warnings of emergency situations, including off hours, weekends and holidays. Ways of Communication tested, how to fix communication failures (driving to office to take orders). How to communicate with patients/staff after emergencies. Procedures for reporting to work for key workers, when the home health agency remains operational discussed Prioritized Active Patients List up to date, (verified during exercise, list completed by dissaster classification) On-Call procedures discussed, tested during exercise Procedures for our agency to assure that all patients in homes, ALFs and /or AFCHs needing continuing care will receive it (resources needed discussed), either from us, through a special needs shelter, or through arrangements made by the patient or the patient’s caregiver, or backup agency, discussed and approved. Procedures for ceasing operation identified, discussed, approved. Step to be Completed Initial, and annual training, material, discussed and approved, added to calendar of in-services. Community Disaster Drill, and Office Fire drill scheduled at least twice a year. Evaluation of exercise form approved. Exercise selected simulates a disaster and exercises the response & recovery roles & responsibilities in a realistic way. Selection of possible community disaster practice was: _________________________________________________________. Community Hazard Vulnerability report completed, discussed and approved Agency Safety meeting schedule, with all needed addendums. Annual Office Safety evaluation discussed, completed. Business Continuation Plan procedures discussed, approved, completed. Agency Safety Tracking Log form approved. Safety Incident report form approved. Page 1 of 2