Department Emergency Checklist/Status Form and Action Plan

Department Emergency Checklist

In the event of an emergency, what are a department's first actions?

The Department Emergency Checklist was created to provide instructions for verifying the safety of employees and the environment within the first 15 minutes following an emergency (ex. major earthquake). This checklist serves as a guideline, departments should consider editing the checklist to include any additional needs (ex. Verify fetal monitors are operational).


Department Emergency Checklist Instructions:

1. Download a copy of the Department Emergency Checklist (must be logged into MyAccess) and complete it.

2. Print form and store with your Department Emergency Action Plan.


3. On page 2 of the Department Emergency Checklist is the Department Status Report. During an emergency, departments may be asked to submit this form to their local Hospital Command Center (HCC). 


Department Emergency Action Plan

The Department Emergency Action Plan (DEAP) is required for every Medical Center Department as per Joint Commission EM Standard EM.01.01.01 to support the overall Emergency Operations Plan (EOP).  

Please note that this DEAP is intended for both patient care and non-patient care departments and serves as a guideline. Departments should customize their DEAP to ensure all department needs are met.   If sections of this DEAP are not applicable to your department (e.g. inpatient vs. administrative office), please leave those areas blank or mark “N/A” as appropriate. 

Department Supervisors/Managers/Directors are responsible for the review and update of their DEAP on an annual basis, and to provide an annual review with all staff.  Keep this DEAP in your Environment of Care (EOC) manual under the yellow tab as it is checked during safety rounds.

Please submit your final draft to [email protected]


Department Emergency Action Plan Instructions:

1. Download a copy of the Department Emergency Action Plan (must be logged into MyAccess) and complete it.

2.  Print the completed plan and store it in your department's Environment of Care Manual. 

3. Send a copy to [email protected]






Copyright © 2017 – UCSF Health Safety Office.  Please direct questions or comments to the website administrator.