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2 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING EMERGENCY DISASTER PLAN FOR FAMILY CHILD CARE HOMES Type or print clearly. Post next to phone. See back for explanation. LICENSEE NAME: DATE: 1. EMERGENCIES - LIFE THREATENING - Call Tell them: Number Calling from: HOME ADDRESS: MAJOR CROSSROAD: HOME DIRECTION FROM CROSSROAD: 2. EMERGENCIES - NON-LIFE THREATENING - List direct local number for the following. Fire/Paramedics: Office of Emergency Services: Physician: Licensing: Ambulance: Other: Hospital: Police/Sheriff: Child Protective Services: Dentist: Poison Control: 3. FACILITY EVACUATION - Some disasters require evacuation of the building. Using a copy of the Facility Sketch (LIC 999), show arrows for the safest way to exit rooms. Be sure that exit doors are not locked from the inside. In the event of a fire, get everyone out, follow the escape routes, meet at a prearranged location, account for everyone, do not let anyone return to the building and call the fire department. 4. TEMPORARY RELOCATION SITE(S) - Some disasters require moving to a safe location. When relocating, determine whether you need food, water, blankets and flashlight and meet at a prearranged location. NAME: PHONE: ADDRESS: NAME: PHONE: ADDRESS: 5. UTILITY SHUT OFF -Locate on the facility sketch with the exit routes. GAS: GAS CO. PHONE: ELECTRIC: ELECTRIC CO. PHONE: WATER: WATER CO. PHONE: 6. EQUIPMENT LOCATION - The fire department may help you with installation information. FIRE EXTINGUISHER: SMOKE ALARM: FIRE ALARM LOCATION ( IF YOU HAVE ONE): TYPE 7. OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, radio and other emergency equipment. LOCATION: LIC 610A (7/03) PUBLIC
3 EMERGENCY DISASTER PLAN EXPLANATION Applicants need to submit a plan to handle possible emergencies. The Emergency Disaster Plan is a plan that identifies resources when an emergency occurs. A copy of the form must be posted in a conspicuous place near a telephone and a copy given to the licensing agency with the application packet. Licensee is responsible for updating information as required and should be typed or legible handwriting. 1. EMERGENCIES - LIFE THREATENING - Whenever a life threatening emergency occurs, use the telephone number. Operators are able to speed dial help for any life threatening emergency. If the call is interrupted, they are usually able to identify the home address from the open line. It is important to write out exactly what needs to be said to direct help to the home. This means that you need to write out the home phone, the address of the home, the nearest major cross street and directions to the home from the cross street. 2. EMERGENCIES - NON-LIFE THREATENING - This is a list of emergency numbers that you will need to call in the event of non-life threatening emergency. Most of the numbers are listed on the form. The "Other" is for other numbers that you think may be needed in an emergency. 3. FACILITY EVACUATION - The most important action in a fire emergency is getting the children safely out and grouped together in a safe location. As part of your application packet, you need to complete a facility sketch. Take a copy of the sketch and identify the quickest exiting routes from each room. Copies of the exiting routes should be posted in conspicuous locations. You also need to identify a safe location where everyone should gather to be sure everyone is counted and no one remains in the building. You need to have regular fire drills with the children. Your fire department is an excellent resource for fire and evacuation instructions. 4. TEMPORARY RELOCATION SITES - You need to make arrangements to move to a temporary site in the event your facility becomes unsafe such as a friends home or local church. You need to develop a second site in the event the first site is not immediately available in the emergency. 5. UTILITY SHUT OFF - In emergencies such as floods and earthquakes, it may be necessary to shut the utilities off. It is important to identify the locations of the utility shut off for such emergencies. You should also have a wrench on hand for the gas line. It also may be helpful to put the utility shut off locations on the Facility Sketch. 6. EQUIPMENT LOCATION - If a fire is just beginning, it may be possible to extinguish the fire with a fire extinguisher after the children are out. The fire extinguisher should be located in an accessible location and be identified with this plan. The local fire department may help you with location of fire equipment. In additional to smoke alarms, you need to identify and locate any other emergency alarms that are on the premise. 7. OTHER EMERGENCY EQUIPMENT - In the event of a flood or earthquake, it may be necessary to have a first aid kit, blankets, food and water, radio, flashlight and other provisions. The plan needs to identify where this other emergency equipment is kept.
4 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY PLAN DE EMERGENCIA EN CASO DE DESASTRE PARA LOS HOGARES QUE PROPORCIONAN CUIDADO DE NIÑOS CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING Escriba a máquina o claramente con letra de molde. Coloque esta notificación junto al teléfono. Vea la explicación en la siguiente página. NOMBRE DE LA PERSONA CON LICENCIA: FECHA: 1. EMERGENCIAS QUE PONEN EN PELIGRO LA VIDA - Llame al Dígales: Número de teléfono de donde está llamando: DIRECCION DEL HOGAR: CRUCE DE CALLES PRINCIPALES MAS CERCANO A SU HOGAR: INSTRUCCIONES PARA LLEGAR AL HOGAR DESDE EL CRUCE DE CALLES PRINCIPALES MAS CERCANO: 2. EMERGENCIAS QUE NO PONEN EN PELIGRO LA VIDA - Anote el número local directo de los siguientes: Bomberos/Paramédicos: Oficina de Servicios de Emergencia: Médico: Oficina de licenciamiento: Ambulancia: Otros: Hospital: Policía/comisario (Sheriff): Servicios para la Protección de Niños: Dentista: Centro para el control de envenenamiento: 3. EVACUACION DEL ESTABLECIMIENTO - Algunos desastres requieren la evacuación del edificio. Usando una copia del "Dibujo del establecimiento (Plano)" (LIC 999), indique con flechas la manera más segura para salir de los cuartos. Asegúrese de que las puertas de salida no estén cerradas con llave por dentro. En caso de incendio, saque a todas las personas, siga las rutas de escape, encuéntrense en el lugar previamente acordado, asegúrese de que todos estén presentes, no deje que nadie regrese al edificio, y llame al departamento de bomberos. 4. LUGARES TEMPORALES DE REUBICACION - Algunos desastres requieren el traslado a un lugar seguro. Cuando se trasladen, determine si necesitan comida, agua, mantas/cobijas y una linterna (flashlight), y encuéntrense en el lugar previamente acordado. NOMBRE: NUMERO DE TELEFONO: DIRECCION: NOMBRE: NUMERO DE TELEFONO: DIRECCION: 5. PARA DESCONECTAR LOS SERVICIOS PUBLICOS Y MUNICIPALES - Encuentre los sitios desde donde se pueden desconectar los servicios públicos y municipales en el dibujo del establecimiento que tiene las rutas de salida. GAS: NUMERO DE TELEFONO DE LA COMPAÑIA DE GAS: ELECTRICIDAD: NUMERO DE TELEFONO DE LA COMPAÑIA DE ELECTRICIDAD: AGUA: TELEFONO DE LA COMPAÑIA DE AGUA: 6. UBICACION DEL EQUIPO - El departamento de bomberos puede ayudarle con información sobre la instalación. EXTINGUIDOR DE INCENDIOS: ALARMA/DETECTOR DE HUMO: UBICACION DE LA ALARMA DE INCENDIO (SI LA TIENE): CLASE: 7. OTRO EQUIPO DE EMERGENCIA - Identifique según sea apropiado, la ubicación del botiquín de primeros auxilios, mantas/cobijas, comida y agua, linterna (flashlight), radio, y otro equipo de emergencia. UBICACION: LIC 610A (SP) (7/03) PUBLIC Page 1 of 2
5 EXPLICACION DEL PLAN DE EMERGENCIA EN CASO DE DESASTRE Los solicitantes necesitan presentar un plan para tratar con posibles situaciones de emergencia. El "Plan de emergencia en caso de desastre" es un plan que identifica los recursos cuando ocurre una emergencia. Una copia del formulario tiene que estar colocada en un lugar visible, cerca de un teléfono y otra copia del plan se tiene que entregar a la oficina de licenciamiento, junto con los otros documentos al mismo tiempo que se presente la solicitud. La persona con licencia tiene la responsabilidad de poner la información al día según sea necesario. La información debe estar escrita a máquina o a mano, con letra que se pueda leer. 1. EMERGENCIAS QUE PONEN EN PELIGRO LA VIDA - Cuando ocurra una emergencia que ponga en peligro la vida, llame al número de teléfono En caso de cualquier emergencia que ponga en peligro la vida, las operadoras pueden llamar rápidamente para solicitar ayuda. Si se interrumpe la llamada, generalmente pueden identificar la dirección del hogar a través de la línea telefónica que queda abierta. Es importante escribir exactamente lo que se necesita decir para que manden ayuda al hogar. Esto quiere decir que usted necesita escribir el número de teléfono y la dirección del hogar, el nombre del cruce de calles principales más cercano, e instrucciones para llegar al hogar desde dicho cruce de calles principales. 2. EMERGENCIAS QUE NO PONEN EN PELIGRO LA VIDA - Esta es una lista de números de emergencia a los que necesitará llamar en caso de emergencias que no ponen en peligro la vida. La mayoría de los números están en la lista del formulario. "Otros" es para otros números que usted piense que pueda necesitar en caso de emergencia. 3. EVACUACION DEL ESTABLECIMIENTO - La acción más importante en caso de una emergencia debido a un incendio es sacar a los niños de una manera segura y agruparlos en un lugar seguro. Uno de los documentos que tiene que completar y presentar con la solicitud es un dibujo del establecimiento. Use una copia del dibujo e identifique las rutas de salida más rápidas para salir de cada cuarto. Las copias de las rutas de salida deben estar colocadas en lugares visibles. Usted también tiene que identificar un lugar seguro donde todos deberán reunirse para asegurarse de que todos estén presentes y de que nadie permanezca en el edificio. Necesita tener ejercicios con los niños regularmente para prepararse en caso de incendio. El cuerpo de bomberos es un recurso excelente para obtener instrucciones sobre incendios y evacuaciones. 4. LUGARES TEMPORALES DE REUBICACION - Necesita hacer arreglos para trasladarse a un lugar temporal en caso de que su establecimiento no sea un sitio seguro. Ese lugar puede ser la casa de un amigo o una iglesia local. Necesita encontrar otro lugar en caso de que el primero no esté disponible cuando ocurra la emergencia. 5. PARA DESCONECTAR LOS SERVICIOS PUBLICOS Y MUNICIPALES - En casos de emergencia, tales como inundaciones y terremotos, es posible que sea necesario desconectar los servicios públicos y municipales. En caso de dichas emergencias, es importante que se identifiquen los sitios desde donde se pueden desconectar los servicios públicos y municipales. Usted también debe tener a la mano una llave de tuerca para cerrar la línea del gas. También puede ser útil poner en el dibujo del establecimiento la ubicación de los sitios donde se pueden desconectar los servicios públicos y municipales. 6. UBICACION DEL EQUIPO - Si un incendio apenas está comenzando, es posible que se pueda apagar con un extinguidor de incendios después de que los niños hayan salido. El extinguidor de incendios debe estar en un lugar fácilmente accesible; también se debe identificar en este plan. El cuerpo de bomberos local puede ayudarle a decidir dónde colocar el equipo contra incendios. Además de las alarmas/detectores de humo, necesita identificar y localizar cualquier otra alarma de emergencia que exista en el establecimiento. 7. OTRO EQUIPO DE EMERGENCIA - En caso de una inundación o terremoto, es posible que sea necesario tener un botiquín de primeros auxilios, mantas/cobijas, comida y agua, un radio, una linterna eléctrica, y otras cosas. El plan necesita identificar dónde se guarda este otro equipo de emergencia. LIC 610A (SP) (7/03) Page 2 of 2
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