Gsa 3415 Form PDF Details

In today’s fast-paced and sometimes unpredictable environment, safety and preparedness are paramount for businesses and organizations. The General Services Administration (GSA) Form 3415 plays a crucial role in ensuring that storefronts, ground-level offices, and other small business spaces have a robust and actionable Occupant Emergency Plan (OEP) in place. Originating as a straightforward guide, this form encompasses various critical components, including emergency contact information for fire departments, police, medical assistance, and the Federal Protective Service, among others. It mandates the establishment of an emergency organization with designated roles such as coordinators, monitors, and a bomb search officer. Furthermore, the form provides guidance on responding to an array of emergencies such as fire, bomb threats, hazardous material incidents, severe weather, civil disturbances, and earthquakes. Each section is meticulously designed to instruct businesses on how to sound alarms, notify official in charge, and specific actions like evacuating the area or taking cover. Additionally, an integral part of the GSA 3415 form is the Telephone Bomb Threat Checklist, which is a detailed protocol for handling bomb threats, capturing crucial information about the threat, and ensuring a calm and coordinated response. This comprehensive approach underscored by the GSA 3415 form is essential for maintaining safety and minimizing the impact of emergencies in workplace settings.

QuestionAnswer
Form NameGsa 3415 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesgsa listing, commercial sales practices format gsa, gsa form 3415 fillable, gsa editable tenent improvement table

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OCCUPANT EM ERGENCY PLAN (Abbreviated)

(This form is provided as a suggested guide for storefront and/or ground level small office space)

AGENCY

ADDRESS

 

 

DATE

NAM ES AND TELEPHONE NUM BERS OF EM ERGENCY CONTACTS

NAME

Fire Depart ment

Police Depart ment

Medical Assist ance

Federal Prot ect ive Service

Building Manager/Lessor

Of f icial in Charge

Bomb Squad

OFFICE PHONE

OTHER PHONE

EM ERGENCY ORGANIZATION INFORM ATION

(COORDINATOR, M ONITORS, AND BOMB SEARCH OFFICER)

NAME

DUTY

OFFICE PHONE

OTHER PHONE

1.

2.

3.

EM ERGENCY PLAN GUIDANCE

IM PORTANT! Know Evacuation Routes. Know the Plan of Action. Be prepared to assist the handicapped.

Bomb Threat Checklist on Reverse Side

 

FIRE OR SM OKE

 

 

BOM B THREAT

 

 

 

 

 

 

 

 

Sound building alarm.

 

 

Record inf ormat ion on back of t his f orm.

 

 

Call Fire Depart ment .

 

 

Not if y Of f icial in charge.

 

 

 

Not if y Of f icial in charge.

 

 

Not if y Police.

 

 

 

Not if y Building Manager/Lessor.

 

 

Not if y Building Manager/Lessor.

 

 

 

Not if y Federal Prot ect ive Service.

 

 

Not if y Federal Prot ect ive Service.

 

 

 

Assist Fire Depart ment .

 

 

Search immediat e area and public areas f or any suspicious

 

 

Evacuat e area immediat ely.

 

 

packages or object s.

 

 

 

 

 

 

 

 

 

Close w indow s and doors (Do not lock)

 

If suspicious package or bomb is f ound:

 

 

HAZARDOUS M ATERIAL

 

 

Do not t ouch.

 

 

 

 

 

Not if y Bomb Squad

 

 

 

 

 

 

 

 

 

Do not handle t he subst ance.

 

 

Evacuat e t he area.

 

 

 

Do not clean t he subst ance.

 

 

SEVERE WEATHER

 

 

Isolat e employees.

 

 

 

 

 

 

 

 

 

 

Keep employees calm.

 

 

Secure object s out side building.

 

 

 

Not if y Federal Prot ect ive Service

 

 

Prepare t o move t o place of saf et y.

 

 

Not if y Fire Depart ment .

 

 

St ay aw ay f rom large w indow s.

 

 

 

Shut of f t he HVAC.

 

 

For t ornado, open w indow s.

 

 

 

CIVIL DISTURBANCES

 

 

Know locat ion of ut ilit y shut of f valves and sw it ches.

 

 

 

 

St ay t uned t o w eat her report s.

 

 

 

 

 

 

 

 

 

Not if y Of f icial in charge.

 

 

St andby f or f urt her inst ruct ions.

 

 

 

Secure all doors.

 

 

EARTHQUAKE

 

 

Not if y Police.

 

 

 

 

 

 

 

 

 

 

Not if y Building Manager/Lessor.

 

 

Take cover under a t able, desk, or in a doorw ay.

 

 

Not if y Federal Prot ect ive Service.

 

 

Do not run out doors.

 

 

GENERAL SERVICES ADMINISTRATION

PREVIOUS EDITION IS NOT USABLE

GSA FORM 3 4 1 5 (REV. 9/2001)

 

 

 

 

 

TELEPHONE BOM B THREAT CHECKLIST

Important: REM AIN CALM

SECTION I - INSTRUCTIONS

Follow inst ruct ions received f rom your supervisor, Federal Prot ect ive Of f icer, or t he designat ed of f icial.

If you are ordered t o evacuat e, t ake w it h you any draf t s, f orms, or report s you may have prepared regarding t he t hreat .

SECTION II - PERTINENT DATA

TIME BOMB/EVENT IS SET TO EXPLODE (AM or PM)

DESCRIPTION OF BOMB OR PACKAGE

EXPLAIN WHY CALLER WISHES TO INJURE OR KILL INNOCENT PERSONS (Use

exact w ords of caller)

 

PRESENT LOCATION OF BOMB OR PACKAGE

 

 

 

BUILDING

 

FLOOR

 

 

 

AREA

WHAT WILL CAUSE THE BOMB TO EXPLODE

DID CALLER INDICATE KNOWLEDGE OF THE FACILITY?

NO

YES (Explain):

SECTION III - DESCRIPTION OF CALLER' S VOICE

MALE YOUNG CALM ACCENT

FEMALE

OLD

NERVOUS SPEECH IMPEDIMENT

MIDDLE-AGE REFINED ROUGH

DESCRIPTION OF VOICE

DO YOU RECOGNIZE VOICE?

NO

YES

IF YES, WHOSE VOICE IS IT?

SECTION IV - BACKGROUND NOISE

TRAFFIC

MUSIC

TAPE RECORDER

HORNS

BELLS WHISTLES

AIRCRAFTS

MACHINERY

RUNNING MOTOR (Type)

OTHER (specif y below ):

SECTION V - TELEPHONE LINE DATA

LINE ON WHICH CALL WAS RECEIVED?

WAS THE LINE A?

 

 

 

LISTED NUMBER?

UNLISTED NUMBER?

IS THIS A NIGHT NUMBER

 

IF YES, WHOSE ASSIGNED NUMBER?

 

NO

YES

 

 

 

HAS A BOMB THREAT CALL BEEN PREVIOUSLY RECEIVED ON THIS NUMBER?

IF YES, EXPLAIN

NO

YES

 

 

 

 

 

SECTION VI - REPORTING OF THREAT

(CAUTION: DO NOT TALK TO OTHERS ABOUT INCIDENT . )

NAME OF PERSON RECEIVING CALL

DIVISION

TELEPHONE NUMBER

REPORT THREAT TO:

FEDERAL PROTECTIVE SERVICE

BUILDING MANAGER/LESSOR

TIME CALL RECEIVED

DATE CALL RECEIVED

PREVIOUS EDITION IS NOT USABLE

GSA FORM 3 4 1 5 (REV. 9/2001) BACK