Date Prepared

Emergency Contact(s) and Alternates

Indicate number of Emergency Contacts

Emergency Contact 1

Contact Name
EX: Plummer Building, Room 104
Home Address

Emergency Contact 2

Contact Name
EX: Plummer Building, Room 104
Home Address

Emergency Contact 3

Contact Name
EX: Plummer Building, Room 104
Home Address

Emergency Contact 4

Contact Name
EX: Plummer Building, Room 104
Home Address

Emergency Contact 5

Contact Name
EX: Plummer Building, Room 104
Home Address

Critical/Essential Department Operations or Services

List in Order of Importance

Indicate the number of essential operations or services for which your department is responsible
EX: John Doe, john.doe@email.com; Jane Doe, jane.doe@email.com


EX: John Doe, john.doe@email.com; Jane Doe, jane.doe@email.com


EX: John Doe, john.doe@email.com; Jane Doe, jane.doe@email.com


EX: John Doe, john.doe@email.com; Jane Doe, jane.doe@email.com


EX: John Doe, john.doe@email.com; Jane Doe, jane.doe@email.com

Planning Readiness Checklist

Indicate the number of items on your Planning Readiness Checklist
Due Date

Due Date

Due Date

Due Date

Due Date

Due Date

Due Date

Due Date

Due Date

Due Date

Essential Resources/Supplies Required for Maintaining Department's Critical Operations


Department's External Communication Plan in the Event of an Emergency

Department's Internal Communication Plan in the Event of an Emergency

Essential Contract Services Required for Maintaining Department's Critical Operations

Indicate number of essential contract services



Essential Travel Required for Maintaining Department's Operations


Additional Department Staff Information

List staff in following format: Name/Phone/Email