Employee Special Needs Emergency Evaluation Assessment Form

Do your employees need special assistance to evacuate during a workplace emergency?

OHS regulations, fire codes and accessibility laws require employers to have emergency response plans that account for ALL individuals at the workplace, including those with disabilities who may need physical assistance to evacuate. The first step is to determine which of your employees have special needs and what those needs are. You can use this self-assessment form to gather that information. Ask employees to return the completed form and notify you of any changes or updates to their conditions. Be aware that the responses are likely to include personal health information that privacy laws require you to keep confidential and not use for purposes other than implementing your emergency response plan.