Personal Emergency Escape Plan (PEEP) Form

Before your visit to ARK coworking, we want to make sure you are safe and equipped to exit the building should there be an emergency.
Please complete this form as soon as possible when booking ARK, before your visit.

This questionnaire is intended to be completed by disabled persons to assist the development of a Personal Emergency Evacuation Plan (PEEP). Please provide as much information as you can to enable us to develop a suitable plan for your visit.

Once completed, the PEEP will be used to assist escape in the event of an emergency. You will be provided with any additional information necessary about the emergency evacuation procedures in the building you are going to attend. If you need assistance, the “Personal Emergency Evacuation Plan” will specify what type of assistance you need. Your host will be available on your arrival to outline your PEEP in person.

Please contact us with any questions.

PEEP Form

Name

First Name

Last Name

Name of Event / Company

Event / Company email

Date of visit

YYYY

Which area of the building are you visiting?

Boardroom

Ground Floor Meeting Room

Office

What is the nature of your impairment that would affect you escaping from the building?

Do you need assistance from others to escape from the building?

Do you need assistance from others to be made aware of an alarm sounding? If so, what assistance would be required?

Designated assistant 1

If Yes to either of the above, who will provide assistance from your group? If possible, select two persons and provide their contact details

First Name

Last Name

Designated assistant 2

First Name

Last Name

If you need assistance in another way, please say how and where