Dental Office Emergency Plan Form
Verify your dental office's emergency preparedness with this comprehensive operational readiness form.
Full Name of Person Completing the Form
*
First Name
Last Name
Date of Emergency Plan Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is the emergency equipment (AED, oxygen tank, first aid kit) present and fully stocked?
*
Yes
No
Not applicable
Are all staff members trained in basic emergency procedures (CPR, evacuation, fire safety)?
*
Yes
No
Training scheduled
Is the emergency contact list (fire, police, local hospital) up to date and easily accessible?
*
Yes
No
Are evacuation routes and exits clearly marked and unobstructed?
*
Yes
No
Are fire extinguishers present, inspected, and within their service dates?
*
Yes
No
Is the emergency plan document current and reviewed with all staff?
*
Yes
No
Have all emergency drills (fire, medical, evacuation) been conducted in the past 12 months?
*
Yes
No
Scheduled
Additional Notes or Observations
Submit Emergency Plan
Should be Empty: