Preliminary Emergency Evacuation Questionnaire for Disabled People

MANCHESTER METROPOLITAN UNIVERSITY.

PRELIMINARY EMERGENCY EVACUATION QUESTIONNAIRE FOR DISABLED PEOPLE.

1.1 INTRODUCTION

1.2 The University owes a duty of care to all students in respect of their health, safety & welfare. This duty extends to the provision of safe access and egress from our buildings.

1.3 Students have an obligation to cooperate with the university in respect of health, safety and welfare issues.

1.4 Therefore, the University may need to provide support and advice for disabled people in the event of an emergency evacuation from our buildings. This process must be completed in good time; therefore, the completion of a preliminary questionnaire is required by all students who have identified a disability in their application.

1.5 An evaluation of all completed questionnaires will be undertaken to ascertain whether the university will need to consult with you and develop a detailed Personal Emergency Evacuation Plan (PEEP) on your behalf.

1.6 The University has a legal responsibility to protect you from fire risks and emergencies. A PEEP may need to be constructed based on the information you provide.

1.7 Should a personal emergency evacuation plan be required you will be consulted on its content, be provided with any additional information necessary about the facilities, support and emergency egress procedures in the building(s) you attend.

2.1 ACTION

2.2 The following short questionnaire must be completed and returned in the self-addressed envelope provided as soon as possible.

The questionnaire is divided into the following sections:

General Mobility Visual Hearing

Please complete the ‘General’ section and any other that may apply.

3.1 GENERAL

3.2 Name

Programme

3.3 If possible, please identify the faculty where you will be based?

Faculty

3.3 Do you currently have a carer or other personal support? Yes No

4.1 MOBILITY IMPAIRED PERSONS

4.2. Could you raise the alarm if you discovered a fire?

Yes No

4.3. Could you open the fire escape doors on the floor(s) you will be using?

Yes No

4.4. Would you require assistance to exit a building in an emergency? (Please note lifts cannot be used in an emergency) Yes No

5.5 Could you use a telephone to call the emergency services?

Yes No

5.6 Will you be a resident in university owned halls of residence?

Yes No

5.7 Are you a wheelchair user?

Yes No

5.8 What is the approximate width of your wheel chair?

5.9 If you use another type of mobility aid, please provide details below

5.10 Could you transfer to an Evacuation Chair (a specialist chair that can negotiate stairs safely) in an emergency with assistance?

Yes No

6.1 VISUALLY IMPAIRED PERSONS

6.2 Could you raise the alarm if you discovered a fire by operating the call point?

Yes No

6.3 Can you open fire escape doors?

Yes No

6.4 Can you use a telephone to call the emergency services?

Yes No 6.5 Will you be a resident in a university owned hall of residence?

Yes No

6.6 Will you require the emergency evacuation procedure to be on tape?

Yes No 6.7 Will you require the emergency evacuation procedure in Braille?

Yes No

6.8 Will you require the emergency evacuation procedure to be in large print?

Yes No

6.9 Will you be able to read the fire escape signs?

Yes No

6.10 Would you require assistance to exit a building in an emergency?

Yes No

7.1 HEARING IMPAIRED PERSONS

7.2 Could you raise the alarm if you discovered a fire by operating a call point?

Yes No

7.3 Can you use a telephone to call the emergency services?

Yes No

7.4 Will you be a resident in a university hall of residence?

Yes No 7.5 Will you be able to hear the fire alarm?

Yes No

7.6 Will you require the emergency written procedures to be provided to you in an alternative format to the standard written instructions?

Yes No

7.7 Do you require the written emergency procedures to be supported by BSL interpretation?

Yes No

7.8 Will you require the provision of a hearing loop or similar device?

Yes No

8.1 FURTHER INFORMATION

8.2 If you have any further information that you may think help us in supporting you while you are the university please detail below:

8.3 Please sign and date the form below

Name Date

Thank you for completing this questionnaire.

The information you have provided will help us to meet any needs for information or assistance you may require

Please return the completed form to: