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.
| Question | Answer |
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| Form Name | Gsa 3415 Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | gsa listing, commercial sales practices format gsa, gsa form 3415 fillable, gsa editable tenent improvement table |
OCCUPANT EM ERGENCY PLAN (Abbreviated)
(This form is provided as a suggested guide for storefront and/or ground level small office space)
AGENCY |
ADDRESS |
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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
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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
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FIRE OR SM OKE |
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BOM B THREAT |
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Sound building alarm. |
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Record inf ormat ion on back of t his f orm. |
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Call Fire Depart ment . |
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Not if y Of f icial in charge. |
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Not if y Of f icial in charge. |
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Not if y Police. |
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Not if y Building Manager/Lessor. |
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Not if y Building Manager/Lessor. |
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Not if y Federal Prot ect ive Service. |
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Not if y Federal Prot ect ive Service. |
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Assist Fire Depart ment . |
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Search immediat e area and public areas f or any suspicious |
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Evacuat e area immediat ely. |
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packages or object s. |
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Close w indow s and doors (Do not lock) |
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If suspicious package or bomb is f ound: |
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HAZARDOUS M ATERIAL |
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Do not t ouch. |
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Not if y Bomb Squad |
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Do not handle t he subst ance. |
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Evacuat e t he area. |
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Do not clean t he subst ance. |
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SEVERE WEATHER |
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Isolat e employees. |
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Keep employees calm. |
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Secure object s out side building. |
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Not if y Federal Prot ect ive Service |
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Prepare t o move t o place of saf et y. |
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Not if y Fire Depart ment . |
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St ay aw ay f rom large w indow s. |
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Shut of f t he HVAC. |
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For t ornado, open w indow s. |
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CIVIL DISTURBANCES |
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Know locat ion of ut ilit y shut of f valves and sw it ches. |
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St ay t uned t o w eat her report s. |
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Not if y Of f icial in charge. |
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St andby f or f urt her inst ruct ions. |
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Secure all doors. |
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EARTHQUAKE |
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Not if y Police. |
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Not if y Building Manager/Lessor. |
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Take cover under a t able, desk, or in a doorw ay. |
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Not if y Federal Prot ect ive Service. |
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Do not run out doors. |
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GENERAL SERVICES ADMINISTRATION |
PREVIOUS EDITION IS NOT USABLE |
GSA FORM 3 4 1 5 (REV. 9/2001) |
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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)
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PRESENT LOCATION OF BOMB OR PACKAGE |
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BUILDING |
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FLOOR |
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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
DESCRIPTION OF VOICE
DO YOU RECOGNIZE VOICE?
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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? |
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LISTED NUMBER? |
UNLISTED NUMBER? |
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IS THIS A NIGHT NUMBER |
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IF YES, WHOSE ASSIGNED NUMBER? |
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NO |
YES |
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HAS A BOMB THREAT CALL BEEN PREVIOUSLY RECEIVED ON THIS NUMBER? |
IF YES, EXPLAIN |
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NO |
YES |
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SECTION VI - REPORTING OF THREAT |
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(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 |