111024234219_0001.pdfAging and Adult Services
FIRE SAFETY EVACUATION PLAN
An Adult Family Home shall have a posted plan for evacuation to safe areas in event of fire. Draw a plan for your home in the
space provided below. Indicate escape routes and designate where staff and residents should meet outside the residence.
Indicate location of fire extinguisher(s) and smoke detectors.
Instructions: Sponsor completes and posts in a conspicuous location
z
W
F,
M
�E
C
C
F
PC
Wlk
-Nj
ti
>4 z
C
0
z
z
4
yr
Z E-4
z
4,
M
�E
C
C
F
PC
Wlk
-Nj
>4 z
C
0
P 0
W
4,
00
Cd
1, 1/s"
",;h
M
�E
C
C
F
PC
Wlk
-Nj
C
W
z
c)
C)
P4 Cn
PCI
211 X'1123
fjy,J� 1 i � I /J � I/ ki, tn
�9
= I