Life Safety - Persons Requiring Assistance Date and time call received Tenant Email Address Suite # This information must be kept current at all times. Tenants must advise and forward update information as it occurs. Data on physically challenged staff should be specific. For example, please indicate where applicable: visually impaired, no hearing, wheelchair, or any other physical challenges that may affect emergency evacuation. Employee 1 Name Reason Requiring Assistance Phone & Extension Floor Location Employee 2 Name Reason Requiring Assistance Phone & Extension Floor Location Employee 3 Name Reason Requiring Assistance Phone & Extension Floor Location Employee 4 Name Reason Requiring Assistance Phone & Extension Floor Location Employee 5 Name Reason Requiring Assistance Phone & Extension Floor Location Submit Leave this field blank
