Form Center

3. Emergency Action Plan

   The Emergency Action Plan (EAP) defines processes for event organizers and staff to follow in the event of an emergency. It also provides event staff information for responders to be able to communicate in a timely manner.  Event organizers shall immediately call 911 in the event of an emergency, and allow City of Roanoke Emergency Personnel to manage the incident. 

6. Name of Event*
7. Type of Event*
9. Date(s) of Event*
   Date(s) of Event Start Date

   —

   Date(s) of Event End Date

   Please list the date(s) of your event.

10. Event Start and End Times*
    Event Start and End Times Start Time

    —

    Event Start and End Times End Time

    Please list the times that your event will start and begin. If over multiple days, please have the start time be the earliest start time, and the ending time be the latest end time. 

12. Event Description*

    Please describe your event. 

16. Event Manager Name*

    Person who has overall responsibility for event.

17. Event Manager Email*
18. Event Manager Phone Number*
20. Alternate Point of Contact*

    Who to contact if Event Manager cannot be reached. Must be different than Event Manager.

21. Alternate Point of Contact Email*
22. Alternate Point of Contact Phone Number*
24. Safety Officer*

    Person/ Company who is responsible for safety during the event. Can be the same as the Event Manager. 

25. Safety Officer Email*
26. Safety Officer Phone Number*
28. Security Officer/ Company Name

    Security company or off-duty police hired to manage security during event. Leave blank if not applicable. 

29. Security Officer/ Company Email
30. Security Officer/ Company Phone Number
32. Will Two-Way Radios be Utilized for this Event? *

    1. Yes
    2. No
33. Please list the Radio Frequencies You Will be Using for this Event Below
37. Event Layout*

    Please describe your event location, including the name and address of the event. Make sure to describe the entire footprint of the event.
    You can upload an event map if you prefer.

38. Map Upload
40. Missing/Lost Persons and Lost/Found Property Location*

    A missing persons description should include the missing persons gender, age, clothing, and last known vicinity.

    If a person discovers lost/found property, the Event Manager will be responsible for safely storing the property.

    Please state the location where people should go to report lost/found item or person, or where a lost/found item or person can be picked up

44. Evacuation Plan

    The purpose of the evacuation plan is to provide for safe, efficient, and orderly evacuation of the event site should severe weather, fire, or other man-made situations warrant such action.

    • Weather Information

    It is the responsibility of the Event Manager and/or Safety Officer to monitor weather radar and they will obtain regular weather reports (event hour at the minimum) from the Blacksburg office of the National Weather Service (NWS) using www.weather.gov. In the event severe weather becomes imminent – either by observed conditions or by the NWS issuing a “warning,” the Event Manager or Security Officer will notify attendees and staff. If needed, contact Emergency Management for guidance.

     

    • In the event that an evacuation is called for, the following announcement should be made:

    “In the interest of public safety, event officials have ordered an evacuation of the area. Please calmly evacuate the event area and seek shelter in your vehicle or at the temporary shelters and safe assembly points as designated: -------- ”

46. Please List the Shelter/ Safe Assembly Point(s)*
47. Upload Map of Evacuation Routes, and Show Shelters/ Safe Assembly Points
51. Medical Plan and Procedures
    • Calls in to 911: 

    Patrons and event staff may call 911 via cellular phone for emergencies that happen on site. Fire-EMS command will coordinate the response. Event staff will assist in locating the patient.

    • Requests on site: 

    Event Staff may discover patrons having a medical emergency on site, upon discovery the information should be immediately relayed to onsite officials (Fire, EMS, Police) if not onsite, event staff will notify the E-911 center and will assist the responding EMS unit in locating the patron.

53. Will Emergency Medical Services (EMS) be Hired for this Event?*

    1. Yes
    2. No

    If you would like to hire EMS units, please call 853-5854 to request EMS, no less than 30 days prior to the event.

54. Please List the EMS Location(s) Here*
58. Electronic Signature Agreement*

    I understand that event staff will need to be briefed on the emergency action plan, the safe assembly points, and will be given maps of the locations prior to the event.

    
    

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
60. Electronic Signature
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field