A.  BI/MULTILINGUAL STAFF MEMBERS
 

NAME	ROOM #	LANGUAGES

Note:  You may need to add additional rows.
 

B.  BOMB THREAT REPORT FORM

Make numerous copies and keep them at switchboard or main telephone for immediate use by operator/secretary.
 

QUESTION TO ASK	ADDITIONAL INFORMATION
1.  When is bomb going to explode?	CALLER'S VOICE    ___ Calm     ___ Nasal     ___ Angry     ___ Stutter     ___ Excited    ___ Lisp      ___ Slow      ___ Raspy     ___ Rapid      ___ Deep ___ Soft      ___ Ragged  ___ Loud       ___ Clearing Throat        ___ Laughter
2.  Where is it right now?	___ Deep Breathing       ___ Cracking Voice     ___ Crying      ___ Normal     ___ Disguised     ___ Distinct       ___ Accent      ___ Slurred     ___Whispered    ___ Familiar
3.  What does it look like?	If voice is familar, whom did it sound like?
4.  What kind of bomb is it?	Additional remarks:
5.  What will cause it to explode?	BACKGROUND SOUNDS   ___ Street     ___ Animal Noises    ___ Static __ PA System     ___ Voices     ___ Music     ___ Motor      ___ Local ___ House Noises     ___ Office Machinery     ___ Phone Booth ___ Long Distance     ___ Cellular    ___ Other
6.  Did you place the bomb?	THREAT LANGUAGE  ___  Foul     ___ Irrational     ___ Incoherent ___ Taped     ___Well spoken/educated    ___Message read by threat maker
7.  Why?	Time of Call:  ______________________ Date:  _________________________________
8.  What is your address?	Sex of Caller:  ____      Age:  _______ Culture:  _____________________      Length of call:  __________
9.  What is your name?	Number @ which call was received:  ________________________________

  Exact wording of threat:
 
 
 

C.  DESIGNATION OF STAFF ASSIGNMENTS/ACTIVITY SITES
 
 

ASSIGNMENT	TITLE	NAME	OPERATION SITE(S)
Decision Making Control	Principal
	Assist. Prin./Designee
Crisis Team	Coordinator
	Sub. Coordinator
Communications/Notifications	Coordinator
	Sub. Coordinator
Evacuation & Shelturing	Coordinator
	Sub. Coordinator
Student Accounting & Release	Coordinator
	Sub. Coordinator
Building Safety & Security	Coordinator
	Sub. Coordinator
Information (Phone & Walk-Ins)	Coordinator
	Sub. Coordinator
Family Contact & Visitation	Coordinator
	Sub. Coordinator
Emergency & Medical Response	Coordinator
	Sub. Coordinator
Support Counseling	Coordinator
	Sub. Coordinator

 

D.  EVACUATION PARTNER SCHOOL/FACILITY

If it becomes necessary to evacuate the school building(s), the Principal, in consultation with the School Superintendent, may decide to transport the students and staff to another county school. The designated partner school is listed below.

This partnership is reciprocal so that if an emergency occurred at the partner school, this school would host students from that school.  This partnership is designed to avoid the problems and liability of dismissing and sending young children home early without proper supervision. This decision will be influenced by many related conditions at the time of the incident � including the time of day, season of the year, urgency of the evacuation, and weather or civil conditions in the community.

The receiving school will use the gymnasium, cafeteria, library or other common area to house the evacuated students for the remainder of the school day. Bus schedules must be adjusted to accommodate these circumstances.
 

Partner School: ______________________________________________________

Location of School: ______________________________________________________

Principal: ____________________________________________________________

Assistant Principal/Designee: __________________________________________

Telephone: _____________________________

Fax: ___________________________________

Capacity: ________________________

Location at Partner School Where Evacuated Students Will Be Sheltered:  _____________

_________________________________________________________________________

Bus Schedule: _______________________________________________________

_________________________________________________________________________
 
 

E.  SCHOOL CRISIS TEAM
 
 

POSITION/NAME	WORK PHONE	HOME PHONE	CELL PHONE/BEEPER
Principal
* Assist. Principal/Designee
* Assist. Principal/Team Coordinator
* Guidance Director
School Nurse
School Resource Officer
School Psychologist
School Social Worker
Secretary
Secretary
Teacher/Administrator/Counselor
Teacher/Administrator/Counselor
Custodian/Maintenance

F.  SCHOOL TRANSPORTATION LIST

G.  STAFF MEMBERS W/CELLULAR PHONES
 
 

NAME	ROOM #	PHONE NUMBER

 

H.  STAFF WITH SKILLS IN MEDICAL CARE
 
 

NAME	ROOM #	TRAINING/CERTIFICATION

 

I.  STAFF/STUDENTS WHO NEED SPECIAL MEDICAL ASSISTANCE IN EVACUATION
 
 

NAME	ROOM #	NEEDS & PERSON ASSIGNED TO ASSIST

J.  STUDENT EMERGENCY RELEASE FORM

I/We request that:

 Student Name  ________________________________________________________

 Student Name  ________________________________________________________

 Student Name  ________________________________________________________

be released to me/us  _________________________________________________________
                                                                             Print your name(s)

his/her/their  ________________________________________________________________
                                                                      Relationship to student

Our intended destination is  ____________________________________________________
                                                                      Location, including address

 Signature:  _________________________________________________________________

Telephone Number:  _______________________________________

************************************************************************************
To Be Completed by School Release Team

___ Requester on emergency sheet � Student Released

___ Requester NOT on emergency sheet but student released to him/her; the student knew
 the requester and felt comfortable being released to the requester. Parent had signed
 appropriate release space.

Time of Release:  ______________   Date of Release:  ________________________
 

Signature of Approval:  _______________________________________________________
 
 
 

K.  ASSAULT BY INTRUDER

Checklist

___ Assess the situation.
___ If continued danger, institute lockdown.
___ Provide first aid.
___ Question victim - make reasonable notes for potential court case:
         -  Description of assailant
 

         -  Report of events
 

___ Contact police (School Resource Officer and/or 911)
___ Notify superintendent.
___ Instruct person answering the telephone to direct all requests to School Board Office
___ Complete police information for charges.
___ Prepare a written memo for staff and parents.
___ Schedule follow-up programs for staff and students.
___ Call emergency staff meeting.
 
 

L.  BOMB THREAT

Checklist

___ Listen carefully to the caller to gain as much information as possible. Notify the building School Resource Officer if the caller is in the building.
___ If the call appears to be a crank call, ask teachers to survey their instruction area and nearby restrooms.
___ If the call could be real and the School Resource Officer is not in the building, call 911 or sheriff�s office immediately.
___ Evacuate the building. DO NOT USE PA SYSTEM OR TURN LIGHTS ON/OFF.
___ Notify superintendent
___ Follow established policy regarding return to the building.
___ If necessary, give contact transportation to arrange for early dismissal.
___ Follow-up activities.

Bomb Threat Report Form:  Make numerous copies and keep them at switchboard or main telephone for immediate use by operator/secretary.
 
 

M.  CHILDNAPPING/LOST CHILD

Checklist

___  Telephone police
___  Call superintendent
___  Notify parents of child
___  Identify team to work on the crisis while rest of school maintains routine
___  Obtain full description and pull out school picture
___  Search school building and grounds
___  If childnapping, try to obtain description of suspect
___  When child is found, contact Superintendent, notify teacher, fill out Crisis Team Report
___  Prepare memo to inform staff and parents of incident and actions taken
___  Arrange for counseling for staff and students, if necessary
___  Call emergency staff meeting
 
 

N.  CRISIS CHECKLIST:  DAY 1

In the event of a serious accident, sudden death, or similar events:

_____ Direct staff and others not to repeat information until verification is obtained.
_____ Notify superintendent.
_____ Convene Crisis Response Team and assign duties.
_____ Notify building support staff, such as counselors, psychologists, and social workers.
_____ Inform closest friends of the affected student and provide support.
_____ Prepare formal statement or announcement.
_____ Announce time and place of emergency staff meeting.
_____ Identify other/additional students, staff, and parents likely to be most affected by news.
_____ Assess need for additional community resources.
_____ Make official announcement.
_____ Hold emergency staff meeting.
_____ As needed, assign team members and other staff to monitor grounds; notify parents, support staff, and feeder schools; provide support to staff; collect
            student belongings and withdraw student from school rolls.
 

O.  CRISIS CHECKLIST:  DAY 2

_____ Gather faculty members and update them on any additional information/procedures.
_____ In case of death, provide funeral/visitation information if affected family has given permission.
_____ Identify students in need of follow-up support and, in accordance with the school�s crisis response plan, assign staff members to monitor the most affected
            students:
                    a. Coordinate any ongoing counseling support for students on campus;
                    b. Announce ongoing support for students with place, time, and staff facilitator; and
                    c. Notify parents of affected students regarding community resources available to students and their families.

Imeediately Following Resolution of the Crisis

_____ Convene crisis response team for debriefing as soon as possible:
                    a. Discuss successes and problems; and
                    b. Discuss things to do differently next time.
_____ Allow staff opportunity to discuss feelings and reactions.

Long-Term Follow-Up and Evaluation

_____ Provide list of suggested readings to teachers, parents, and students.
_____ Amend crisis response procedures as necessary.
_____ Write thank-you notes to out-of-building district and community resource people who provided (or are still providing) support during the crisis.
_____ Be alert on crisis anniversaries and holidays. Often students will experience �anniversary� grief reaction the following month or year on the date of the crisis,
            or when similar crises occur that remind them of the original crisis. Holidays, too, often are difficult for students who have experienced loss.
 

P.  DISASTER

Destruction of Part/Whole of Building (e.g., tornado, plane crash, bomb)

Checklist

___ Call 911 or Sheriff�s Office (346 7777)
___ Obtain information on extent of damage.
___ Evacuate using fire alarm or move students to safe areas in building.
___ Assign one adult to supervise others in attending to the injured.
___ Assign staff member to assist rescue personnel.
___ Call superintendent and School Resource Officer.
___ Arrange for dismissal of students.
___ Handle all distribution of information to public through School Board Office
___ Call emergency staff meeting.

Danger from Outside Preventing Dismissal/Evacuation
(e.g., hurricane, tornado, sniper, plane crash)

Checklist

___ Gather information.
___ Identify safe areas in building.
___ Direct staff to escort students to identified areas.
___ Call superintendent�s office and School Resource Officer.
___ When situation is �clear,� return students to class.
___ Prepare memo/letters to inform staff and parents.
___ Distribute information to public via Superintendent�s office.
___ Call emergency staff meeting.
 

Q.  FIRE/ARSON/EXPLOSIVES
 

Checklist

___ Sound alarm; evacuate building.
___ Call 911 or Sheriff�s Office (346 7777)
___ Determine if there are any serious injuries.
___ Call superintendent
___ Arrange transportation for dismissal.
___ Determine building status for return to classes.
___ Follow-up activities.
___ Call emergency staff meeting.
 
 

R. GAS LEAK

Checklist

___ Turn off the main gas valve. Location:  _________________________________
___ Phone Fire Department
___ Phone Director of Maintenance
___ Phone gas company

If time permits, phone the superintendent�s office to alert that office of the current situation.

Keep students at a safe distance until the problem has been corrected.
 
 

S.  HOSTAGE *
Armed/Dangerous Intruder

Checklist

___ Contact 911 or police
___ Instigate lockdown procedures; after police arrive, if the danger is confined, orderly evacuation way from the danger may occur.
___ Notify superintendent.
___ When police arrive, in accordance with pre-planning, they assume control of incident and negotiations.
___ No school personnel should circulate through building; after evacuation, no individuals should enter or re-enter the building.
___ Instruct person answering the phone to direct all requests superintendent�s office.
___ Keep telephone lines open for police use (pay telephones as well).
___ Provide information to police about the building layout and what is known about the background of the hostage taking.
 
 

T.  INTRUDER or Trespasser

Checklist

___ Determine the whereabouts of the intruder/trespasser.
___ Isolate the individual.
___ Determine the extent of the crisis.
___ Make reasonable notes for potential court case.
___ Contact police - 911.
___ Move other students and staff from area.
___ Notify superintendent.
___ Instruct person answering the telephone to direct all requests to superintendent�s office
___ Complete and submit police information for charges.
___ Prepare a written memo for staff and parents.
___ Complete Crisis Team Report.
___ Call emergency staff meeting.
___ Schedule follow-up activities for staff and students, including security plan review.
 
 

U.  LIFE-THREATENING CRISIS

(Major) Life-threatening Injury to Individual

When a life-threatening situation is perceived to exist, a building administrator or person in charge of a building or office should:

First Actions

___ Call 911 or sheriff�s office (346 777)
___ Apply first aid and life-sustaining techniques using trained persons on staff.

Names: ______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________
 

___ Call parent/guardian immediately.
 
 

V.  RAPE RESPONSE

Checklist

School involvement in incident due to:

___ Rape occurrence on campus
___ Survivor�s family requests school intervention
___ Survivor�s friends request intervention
___ Rumors and myths are widespread and damaging
___ Students witness police/emergency services
___ Information provider/recipients enjoined not to repeat information elsewhere.
___ Steps taken to protect survivor�s identity and right to privacy.
___ Law enforcement and rape crisis agency notified if appropriate.
___ Crisis Response Team member closest to victim designated to talk with student and determine type of support and support provider desired.
___ The rape survivor is encouraged to seek additional support from community rape crisis agency.
___ Space provided on site for rape survivor and identified peers to receive support services.
___ School services coordinated as appropriate and legal with outside service providers.
___ Action taken to quell rumors.
___ All records related to rape incident and services provided stored in confidential file.
 
 

W.  SHOOTINGS/WOUNDS/ATTACKS
 

Checklist

___ Assess the situation
___ Call:
             - 911 or sheriff�s office (346 777)
             - School Resource Officer
             - Ambulance
___ Use emergency signal - all students and staff are to stay in classrooms, securing the door, and staying on the floor.
___ Establish a command post with several telephones available.
___ Implement first aid procedures until rescue service arrives.
___ Notify superintendent�s office.
___ Keep a written log of events.
___ Prepare a written memo for staff and parents.
___ Implement necessary follow-up activities.
___ Call emergency staff meeting.
 
 

X.  WEAPONS SITUATION

Checklist

___ Assess the situation.
___ Notify police.
___ Gather information.
___ Isolate individual or suspect.
___ Do not use force or touch the person or weapon.
___ Remain calm.
___ Tell another administrator what the situation is.
___ Use emergency signal to notify teachers of the threatening situation and have teachers keep students in classroom until all is clear.
___ Notify superintendent.
___ Refer media questions to the superintendent�s office.
___ After immediate situation is resolved, hold emergency staff meeting before staff members leave for the day.
 

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