Life Safety – Persons Requiring Assistance

YYYY slash MM slash DD

This information must be kept current at all times. Tenants must advise and forward updated 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.

Confidential Information

Person 1

Person 2

Person 3

Person 4

Person 5

Person 6

This field is for validation purposes and should be left unchanged.