Dental office plan table of contents



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Emergency Action Plan

________________________


(name of dental office)
_______________

(date)
This Emergency Action Plan has been developed to help prepare for an office or community emergency. By preplanning and practicing our response, the negative outcomes to our patients, our staff, our community and ourselves can be minimized. In every case, your first priority is always the health, safety and well being of your staff, patients and yourself.





  1. Risk Assessment:

Based on our mode of operation and our geographic location we have identified the following potential threats: (cross out those not relevant)





fire

tornado

earthquake

hurricane

winter storm

explosion

flood

power outage

disease outbreak

chemical spill

civil disturbance

terrorist threat

communication

failure


electrical disruption (including

lightening)



radiation exposure

water contamination








other _________________________________________________

The following potential flammable materials have been identified as fire hazards: (cross out those not relevant)


ITEM LOCATION

1. Oxygen tank(s)

2. Acrylic monomer

3. Bunsen Burners (natural gas)

4. Isopropyl Alcohol

5. Ammonia

6. Listerine (contains alcohol)

7. Occlude (contains butane)

8. Zarosen (contains alcohol)

9. Harvey Vapo Sterile solution (large amounts)

10. Butane Torch

11. Other


Certain flammable items may require special storage and handling due to the volatility or to the quantity of material present. Examples may include methylmethacrylate (acrylic monomer) or oxygen. The following items have additional handling or storage requirements:

ITEM LOCATION

1.


2.
{It is advisable to alert the local Fire Department if you have any material in these categories. They may choose to have your facility map and chemicals locations on file at the Fire Station.}



  1. Emergency Reporting and Alarm system:

In case of emergency, ______________________________ (name(s) of dentist or staff person) should be notified. He/She will determine to what extent the Emergency Action Plan should be executed. The alternate is _______________________________.


The emergency phone number is 911. Whenever possible a land phone should be used to call 911 as the emergency system has automatic tracing. This may trace a cell phone to the cellular tower which may not be located in the town in which the emergency is occurring.
In case of fire, the alarm will automatically sound. The alarm system is / is not (circle) directly linked to the Fire Station. The fire alarm sounds like ______________________________.
An automatic sprinkler will / will not (circle) activate. The office has fire extinguishers. They are located ______________________________.
Employees are / are not (circle) trained in and encouraged to utilize fire extinguishers.


  1. Evacuation or Shelter in Place:

The nature of the emergency will determine if evacuation or sheltering in place is advised. This will be determined by _____________________________ (name).

The alternate is _____________________________ (name).
Time should not be taken to retrieve personal items.

No person can be forced to evacuate or shelter in place against his/her will.
The evacuation meeting site is _______________________________ (list).
Alternate evacuation meeting site is ______________________________ (list).
The sheltering in place location is ______________________________ (list).
The shelter in place location has been stocked with various things that may be necessary during an emergency. These items are located ______________________________.
It is of primary importance to know that all persons have been accounted for. It is of secondary importance to maintain computer and financial records. The following items will be gathered and brought to the meeting place:



Item

Person Responsible

Alternate Person

Daily patient schedule







Employee list







Computer back up tape(s)







Financial papers







Other








At no time should these documents be retrieved at the risk of personal injury.


  1. Emergency Exit Route(s):

All persons are to leave through the nearest exit. Elevators should not be used during evacuation. Each doctor / assistant / hygienist is responsible for assisting the patient to whom he/she is currently providing treatment. The receptionist(s) are responsible for notifying and escorting any people from the reception area.


A Facility map is / is not (circle) available and is located ______________________________. It is also advisable to have a facility map included in your emergency action plan.
Exit routes are clearly marked by ________________________________

_________________________________________________ (describe). It is recommended that an additional lighted exit sign be located on the floor, near each exit.


Wheelchair accessible exits are located at all exits or________________ ________________________________________________________________ (list). Multiple story buildings need to have a designated handicap accessible rescue area on each floor. These areas are located ______________________________.
Emergency lighting will / will not (circle) turn on automatically in case of power outage. Flashlights are kept ______________________________ (location).



  1. Plan Review and Training:

It is vitally important for employers and all employees to be comfortable with the contents of the plan, to have practiced the implementation of the plan and to know the location of the written plan document. Emergency responses may not be second nature and may not be executed perfectly, but they will go much smoother if all have a working knowledge of his/her responsibilities. The Emergency Action Plan should be reviewed at least annually. This should be completed by _______________________________________________ (list the name of staff or dentist).


Training shall be conducted whenever there is a change in the plan; within 30 days of the start date for a new employee; and annually. Dr. __________________________ or_________________________ (staff) shall be the responsible for scheduling and implementing the training and maintaining the Training Log ( pg 10).

VI. Plan Locations:
All employees may review the Emergency Action Plan. A copy is located _______________________________________________ (list locale).
In addition, a copy of the Emergency Action Plan shall be kept:

- in the doctor’s office ( list locale) ______________________________


- by the office manager (list locale) ______________________________
- at the doctor’s home (address) ______________________________
- in the computer (list program/ file name) ______________________________



  • other (list locale)

______________________________



  1. Office Assets Listings:

After the initial phase of an emergency is over, it will be necessary to contact various persons (insurance agent, accountant, WDA, venders, etc) to begin recovery. The employees’ relatives may need to be contacted. A listing of building contents may be needed. In order to account for your assets, it is advisable that a video recording and/or photos of your equipment be kept outside the office. Loss prevention specialists suggest you select a location at least 50 miles away. If you keep them nearby, consider purchasing fire resistant, water-tight storage for critical files. In addition, it is suggested that a running inventory of consumables be kept. Pages 19-26 list our assets.




  1. Contacting Patients

It is advisable for dental offices to have a plan in place for rerouting phone calls, in preparation for a disaster. Phone calls should be forwarded to a phone that has an answering service so patients can be directed on where to get emergency care. Also, it is recommended that the dental office keep a current set of mailing labels offsite, either on paper or on disk, so that a letter can easily be sent out to patients, if a disaster should occur. Data recovery is dependant on how often and how well you perform back-ups. Test your back up systems! Many recovery plans have failed because operators thought files were successfully copied from one source to another, only to discover their back-up discs were empty.


Lastly, in case the disaster causes physical injury to the dentist, it is important that the dentist provide a referral for a recommended dentist. The name of the referral dentist is ______________________________ (list name). Dr. ______________________________’s phone number is ______________________________.

IX. Disaster Log
A chronological record (pg. 30) of events should be kept and started as soon as feasible. This will be maintained by ______________________________ (name).

TRAINING LOG FOR: _________________________



(name of office)


DATE

PRESENTER

TOPICS

ATTENDEE SIGNATURES

































































































































































































































































































































































































EMPLOYEE LISTING FOR: _________________________

(Name of office)



LAST UPDATE: / /


EMPLOYEE























SPOUSE























HOME NUMBER























CELL NUMBER























E-MAIL ADDRESS























ALTERNATE

E-MAIL ADDRESS






















HOME ADDRESS























OTHER EMERGENCY CONTACT






















EMERGECNY

CONTACT’S PHONE NUMBER





















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