NOTE:

For official copies of board policies and procedures please contact the superintendent's office at (253) 583-5190 or email supt@cloverpark.k2.wa.us

Form 3412-F4

CLOVER PARK SCHOOL DISTRICT
Building Annual Emergency Action Plan (EAP) for
Sudden Cardiac Arrest (SCA)

Prepare and maintain this form with the AED system when stored prior to use. Maintain a copy in the Building Safety Plan.

Building: Date:

  1. The on‐site coordinator of this EAP is (i.e., school nurse or athletic trainer):
  2. Number of AEDs on schools grounds:
  3. The AEDs are located in:
  4. EMS system AED(s) are registered with: (West Pierce Fire and Rescue or JBLM Fire and Rescue):
  5. The following individuals have been trained in CPR and AED use (i.e., administrators, coaches, physical education teachers, athletic trainers, nurses, and safety and security personnel):
  6. During school hours, the following individuals are identified as our school emergency response team to a possible sudden cardiac arrest:
  7. In case of an emergency during school hours, the school/facility office is notified and the response team is alerted of the emergency and the location via the school’s internal radio or public address system. The school/facility office will also active the EMS system by calling 9‐1‐1.
  8. For athletic or school events occurring after school hours, access to the AED is maintained through (i.e., unlocked office and cabinet):
  9. In case of an emergency after school hours, the AED will be retrieved and used by trained or voluntary responders closest to the emergency. If a local response team is also available, they are notified by (list individual below) The EMS system will also be activated by calling 9‐1‐1.
  10. The transportation route for ambulances to enter and exit the school to each sporting facility and places of assembly has been determined and are posted (list location below):
  11. We practice and review our EAP and response to a possible sudden cardiac arrest annually. The following personnel are included in this rehearsal:
  12. If a sudden cardiac arrest or AED use occurs, the following individuals (with phone numbers) will be notified (i.e., administrators, EAP Program Coordinator, crisis counselors, and Risk Manager):
  13. Emergency Action Plan for Sudden Cardiac Arrest S building or sporting facility:
  14. Street Address:

Contact with First Responders: