Organisation Resilience Workbook

Organisational Resilience Workbook
Table of Contents
INTRODUCTION TO BUSINESS CONTINUITY MANAGEMENT (BCM) ......................................................... 1
INTEGRATED BCM PROCESS ........................................................................................................................ 2
OVERLAPPING CLUSTERS OF ACTIVITIES AND PLANS ............................................................................ 3
CRITICALITIES AND SUCCESSES.................................................................................................................. 5
RESILIENCE STRATEGIES.............................................................................................................................. 6
SPECIFIC PLANNING STEPS .......................................................................................................................... 7
RELOCATE OR STAY? .................................................................................................................................... 8
HOW PREPARED ARE YOU? .......................................................................................................................... 9
DISCLAIMER
The information provided in this
document is intended for general use
only. It is not a definitive guide to the
law and best practice, does not
constitute formal advice, and does not
take into consideration the particular
circumstances and needs of your
organisation. Every effort has been
made to ensure the accuracy and
completeness of this document at the
date of publication for this general
use.
KEY QUESTIONS TO ASK (AND HAVE ANSWERS TO).............................................................................. 11

BUSINESS CONTINUITY PLANNING TEMPLATE ........................................................................................ 12
Organisational Resilience Workbook (May 2010) - This document is not intended as a best practice guide, nor should it be seen as a definitive reference tool.
Page 1 of 70
Introduction to Business Continuity Management (BCM)

BCM (and emergency management) is concerned with considering what to do when it all goes wrong, and making sure that people and clients are not
inconvenienced or put at risk when something does goes wrong. It should be undertaken by an organisation to manage its business and service
continuity risks, and to respond to community or external emergencies. It should be based on a whole-of-organisation, all-hazards, all-agencies and
community-focused approach, whereby all parts of the organisation must be involved in BCM within the community the organisation is operating in.
The primary objective of BCM controls, strategies and plans is to ensure the uninterrupted availability and resilience of key or time sensitive resources
and dependencies so that it supports the organisations critical business processes, operations and services.
In essence, BCM is a holistic but integrated management process that provides a robust framework for building resilience with the capability and
capacity for effective timely responses to potential events, regardless of cause (an all-hazards approach), which affect the organisation.
BCM also seeks to protect the interests of key stakeholders, organisational reputation, brand and value-creating activities. All decisions on how
organisations respond to incidents, regardless of cause, should be driven by the following basic principles:
Always put the health, security and safety of people first (duty of care and legal/ regulatory obligations).
Always seek to provide and manage factual, rapid and transparent communications.
To be effective, we need to pay attention to the following principles1:

BCM is part of the organisations risk management that considers a wide range of strategic and operational risks that have the potential to disrupt
the achievement of organisational objectives.
BCM is an important contributor to the overall organisational resilience.
BCM assists organisations to continue achieving its objectives.
BCM drives organisational preparedness for managing disruptive events, proactively treating risk and establishing capability to manage potential
impacts.
BCM builds organisational capability to mitigate the likelihood of events occurring, and to respond to, manage and recover from these events.
BCM seeks to understand organisational requirements for people, processes, information, assets and technology that will contribute to the
achievement of its objectives through the conduct of BCM.
BCM is an iterative process that is continually monitoring and reviewing external and internal contexts for change and responding to that change.
BCMs iterative process drives continual improvement so that it contributes to organisational preparedness and resilience.
Draft AS/ NZS5050:2009 BCM standard
Page 1 of 70
BCM is focused on the understanding of uncertainty and how organisations could respond to and manage that uncertainty.
BCM provides an analytical framework which assists decision makers in making informed choices on the management of continuity risk and events.
Integrated BCM process

BCM should be integrated with the organisations existing overarching organisationalwide risk management framework and processes.
BCM goes well beyond implementing a simple process and writing business
continuity plans and strategies. Strategies and plans need to be flexible and adaptive,
and decision makers need to appreciate the uncertainty and complexity of an event
(e.g. transfer/ relocation to an alternate facility/ location).
BCM should reflect the organisations unique culture and comprise a comprehensive
set of activities that are appropriately integrated into organisational learning and
improvement.
Risk Assessment
Risk Identification
Risk Analysis
Risk Evaluation
(Business Impact Analysis)
Developing Capabilities
Risk Treatment
Establishing Strategies
Maintenance
Actions &
Resources
Plan
Documentation
Incident
Communications
Monitoring & Review
The process for BCM is represented in the diagram on the right2.
Establishing the Context
Communication & Consultation
BCM is a cyclical risk management process as described in ISO 31000:2009 risk

management standard (draft). It is an iterative process whereby the outcomes of
each stage are used to challenge and review the assumptions and outcomes of
previous stages, through the monitoring and review process.
Establishing Understanding
Plan Activation & Deployment
Draft AS/ NZS5050:2009 BCM standard
Page 2 of 70
Overlapping clusters of activities and plans

There are six (6) overlapping, non-linear, clusters of activities that organisations have to consider doing before, during and after a disruption or an
emergency. These activities depend on the circumstances, impact, and organisational context and maturity. They overlap because one or more of these
activities can be activated concurrently and/or sequentially, in no particular linear order or sequence.
These six overlapping clusters of activities are:
Risk management prevention and risk mitigation.
Response immediate management (in response to an

event/ emergency/ crisis/ disaster).
Recovery to recover interim/ partial services and/or

operations.
Restoration to restore to full service and operations.
Resumption normalisation, back to business as usual

services and/or operations, where possible/ practical.
Control and/or command governance structures that

manage these six (6) overlapping clusters of activities.
Risk Mgt Prevention/

Mitigation
(Risk Mgt
Policy &
Plan)
Response
Resumption
(Resumption
Plans)
Risk management policy and plan an overarching

framework and process to communicate and consult with
stakeholders, establish the context, identify, analyse,
evaluate, treat, monitor and review risks.
Crisis/ media management planning steps taken to
maintain reputation and to execute the relevant
communication and media management strategies or
protocols/ plans.
Control &
Command
(Governance
Structure &
Crisis/ Media
Mgt Plan)
Corresponding to these activities are strategies and plans that

collectively bring together the following topics and planning into
either one single document (for smaller organisations) or several
documents (for larger organisations):
(Response &
Contingency
Plans)
Restoration
(Restoration
Plans)
Recovery
(Recovery
Plans)
Page 3 of 70
Response planning - steps taken to immediately respond to the disruption or emergency, ensuring human safety and security, and maintaining
communication.
Contingency planning - steps taken to activate or restore alternate processes, systems and physical locations/ facilities, where appropriate and
necessary.
Recovery planning - steps taken to restore specified critical and/or key infrastructure requirements/ dependencies such as utilities,
communications, supplies and technology.
Restoration planning - steps to provide limited to normal business services and/or operations, like rebuilding a fire damaged building.
Resumption planning - steps to bring service levels, operations and/or facilities back to business-as-usual, or providing back-to-normal services
to customers from minimum service levels.
Due to inter-dependencies with other agencies (federal, state and municipality), an integrated, multi-agency organisational response at local, regional
and national level may also be required, especially during a wide-spread community emergencies like bush fire or floods.
A BCM program involves an integrated organisational-wide process of:
Establishment of the program/ project (with strong Board and management mandate and commitment).
Development of the organisations BCM policy and framework (linked to your organisations risk management framework).
Risk assessment and impact analysis (using criticality and dependency worksheet)
Establishing governance structures for incident command, management, recovery and support.
Development of cost-effective intuitive strategies and plans that are aligned to organisational objectives.
Development and testing of strategies and plans
Reviewing, maintenance, training and auditing of strategies and plans.
Page 4 of 70
Criticalities and successes

A committed Board or Management should be satisfied that sufficient infrastructure, budgetary and other resources are allocated and maintained in
order for your organisation to be able to: (i) fulfil the long-term objectives of a BCM program; and (ii) continuously develop, maintain and implement
relevant strategies and plans throughout the life of your organisation. The BCM program is therefore a continuous journey, rather than an end in itself. It
is a long-term commitment by the organisation.
For BCM to be successful, it is necessary to focus on the following performance drivers:
Structured co-ordination - highly structured co-ordination and management arrangements ensure that all planning and systems, from the first
response to recovery (restoration and resumption), are aligned to organisational objectives, and well understood and communicated to all
stakeholders, with roles and responsibilities clearly defined and documented.
Workforce capabilities - develop workforce capability and competencies through plans, skills training and adequate provision of technical
equipment and committed resources.
Capacity building - build capacity planning dimensions into services and/or operations, including escalation processes and systems to manage
possible surges in demand for services and service provision.
Inter-operability of plans - ensure inter-operability of planning, co-ordination and operational activities, with diverse arrangements and interconnectedness with other component parts of the system and with other external stakeholders like ambulance and police.
Regular exercising and testing of strategies and plans is essential. It ensures that disconnections, omissions and dependencies within strategies and
plans are fixed before they are used in reality. Testing challenges assumptions made during the planning process. As such, it is important to:
Test the system and dependencies, and readiness of all stakeholders.
Exercise and review strategies and plans.
Ensure people are rehearsed in how to respond and fully understand their roles and responsibilities.
Regularly update and maintain strategies and plans, especially emergency contact lists.
Page 5 of 70
Resilience strategies
Critical concepts in business continuity and emergency management are (i) recovery time objective (RTO); and (ii) maximum acceptable outage (MAO).
RTO is the period of time required to fully re-establish adequate resource requirements (HB221:2004), whilst MAO is the maximum period of time that
critical business processes (or services) can operate before the loss of critical resources affects operations (HB221:2004). For example, the RTO for an
emergency department is 10 minutes and its MAO is four hours.
Strategies and plans need to have acceptable RTO and MAO that are aligned with the organisations objectives, risk management framework and risk
appetite, and in compliance with applicable regulatory and contractual service obligations.
Strategies and plans should also be intuitive and options include, but are not limited to:
Process transfer or relocation involves transfer or relocation of critical and/or time sensitive activities either internally (e.g. to another part or
location of the organisation) or externally (e.g. to a third party location), independently or through a reciprocal/ mutual-aid agreement, or in-principle
agreement.
Agreement to share resources through mutual aid arrangements (e.g. shared data centre).
Temporary/ manual workarounds as an alternative to transferring or relocating people or processes, it might be feasible to adopt a different way
of working that provides an acceptable result in the short to medium term (e.g. using the stairs rather than lifts).
Change, suspend or terminate services, functions or processes - provided conflicts with the organisations key objectives, statutory compliance
or stakeholder expectation are managed appropriately.
Insurance for financial compensation for losses, used in combination with other strategies.
Page 6 of 70
Specific planning steps

The planning steps are show in the diagram below.
Test,
Test,Review
Review&&
Improve
ImproveYour
Your
Strategies
&Plans
Strategies &Plans
Understand
UnderstandYour
Your
Business
&
Engage
Business & Engage
The
TheRight
RightPeople
People
Communicate
CommunicateYour
Your
Strategies
&
Plans;
Strategies & Plans;
Staff
Staff&&Community
Community
Training
Training
Identify
IdentifyCritical
CriticalServices,
Services,
Dependencies,
Dependencies,
Capabilities,
Capabilities,Capacities
Capacities
Identify
IdentifyRisks,
Risks,
Weaknesses,
Weaknesses,
Vulnerabilities,
Vulnerabilities,
Expectations
Expectations
Make
Make&&Challenge
Challenge
Assumptions
Assumptions(Ask
(Askthe
the
Right
Questions!)
Right Questions!)
Develop
Develop&&Implement
Implement
Strategies
Strategies&&Plans,
Plans,
Governance
Structure
Governance Structure
Identify
IdentifyIntuitive
Intuitive
Strategies
Strategies&&Plans
Plans
Page 7 of 70
Relocate or stay?
Key decisions as to whether your organisation evacuates or stay-in-shelter in an emergency are shown in the overall mind map below:
External Factors
Internal Factors
Notes
(1) There is no compulsory evacuation
Advance Planning/
Coordination
Time
Impact
Nature of
Event
Physical Structure
Likelihood
Metro
Rural
Location of
Facility
Fire Zone
Hurricane
Zone
(2) Responsibility for recommending

relocation rest with Incident
Controller.
Decision to
Relocate
or ShelterIn-Place
Communication
Resident Acuity/
Safety/ Security
Staff/ Workforce
Flood Zone
in Victoria.
Type of
Zone
Suppliers/
Dependencies
(3) The rights of people to stay and

protect their homes are recognised.
(4) Recommendation 7.1 of the
Interim Bushfire Commission
Report (August 2009) states the
principle that practical steps are
needed to protect the vulnerable.
Families with young children,
Transportation/
Evacuation Route
Destination
older people and disabled people

(sic) are advised to plan for early
relocation.
(5) If you are planning to leave the
property, leave early. Avoid the
wait-and-see approach.
Page 8 of 70
How prepared are you?

This simple checklist will help you identify just how prepared you are for an emergency?
Has your business ...
Yes
No
Action Plans/ Gaps?
1. Documented business continuity/ emergency management strategies and plans

2. Checked to see whether business is complying with relevant legislation, laws, duty of care, etc.
3. Documented aims and objectives for the organisations business continuity/ emergency management strategies and
plans
4. Established a project team/ planning committee
5. Established a control/ governance structure for the organisation, including the appointment of appropriate people to
specific roles and responsibilities
6. Developed a process for ongoing maintenance and review of strategies and plans and updating of information
7. Hosted an ongoing program of awareness, education and training for staff/ volunteers, patient/ residents,
contractors and visitors
8. Documented and made readily accessible emergency contact lists of all internal and external stakeholders
9. Held regular scenario testing to train staff/ volunteers and test business continuity/ emergency management
strategies, plans, dependencies and arrangements.
10. Conducted an annual risk assessment for the business and its operations
11. Given priority to training staff in areas of key risks
12. Included familiarisation with business continuity/ emergency management strategies and plans as part of the staff/
volunteers induction/ training process
13. Developed building evacuation plans and held regular practice drills
14. Considered the special needs of people with disabilities, etc, in building evacuation plans
15. Established a system to account for all people on your premises (head count management)
16. Established a system to log/ document events in the case of an emergency incident
17. Spoken to your neighbours or community about continuity and emergency planning
18. Established a process for (i) emergency equipment maintenance; and (ii) documented emergency contact lists/
numbers of staff/ volunteers, patient/ residents next-of-kin, suppliers and authorities
19. Mapped comprehensive building floor plans and site maps, identifying dependencies including power, water and gas
supplies, local roads, neighbours, communities, etc
Page 9 of 70
Has your business ...
Yes
No
Action Plans/ Gaps?
20. Established strategies and plans for (i) maintaining and activating emergency contact lists for key stakeholders; (ii)
relocation of facilities/ services or stay and shelter-in-place; (iii) patient/ resident transportation/ transfers; (iv)
maintaining staff and patient/ resident welfare and support; and (v) media management
Check your results

For a perfect score you should answer Yes to all 20 questions.
If your score is 17 to 20
Congratulations! Your business or organisation is definitely one of the best in the area of emergency/ contingency planning.
But dont be complacent - things change every day and so there is always maintenance work required.
If your score is 11 to 16
Your organisation is more prepared than most but if there is an emergency/ crisis that impacts on your business or
organisation, chances are you wont have anticipated all of the potential consequences or be adequately prepared to
respond. Put emergency planning on your Board and/or Management agenda.
If your score is 10 or less
Your organisation is not well prepared and needs to take immediate action or the consequences could be drastic for your
business, staff/ volunteers and patient/ residents in the event of an emergency, including damage to your reputation.
(Adapted from Mind Your Business: An emergency management planning guide for business in the City of Melbourne)
Page 10 of 70
Key questions to ask (and have answers to)

(1)
Which alternate locations/ facilities have been identified if the stay and shelter-in-place option is not
appropriate?
(2)
In what order of priority (triage) are people evacuated3 from your buildings? Process/ procedure in place to verify that all rooms/
buildings have been fully evacuated/ relocated/ cleared?
(3)
How will you ensure each patient/ resident is clearly identifiable before, during and after relocation/ transfer to alternate locations/
facilities?
(4)
What are your process/ procedure for ensuring that your staff/ volunteers are available to care for patient/ residents at all alternate
facilities/ locations?
(5)
What are your processes/ procedures for notifying patient/ residents emergency contact person of a decision to relocate/ transfer to
another location/ facility or to stay and shelter-in-place?
(6)
How are patient/ resident-specific treatment supplies/ requirements identified for transportation to the alternate location/ facility?
(7)
How will you obtain all necessary supplies/ inventories if you: (i) evacuate/ relocate to alternate locations/ facilities, or (ii) decide to
stay and shelter-in-place?
(8)
What are your process/ procedure for transporting patient/ residents medications/ supplies to alternate locations/ facilities?
(9)
What are the three (3) most critical resources or dependencies used in your organisation (under normal business-as-usual
operating conditions), e.g. electricity, pharmacy supplies, linen etc.?
(10)
How will you manage your patient/ residents care if medical records/ documentation are destroyed and/or are not available?
3
Evacuation is a risk management strategy which may be used as a means of mitigating the effects of an emergency or disaster on a community. It involves the movement of people to a safer location. However, to
be effective it must be correctly planned and executed. The process of evacuation is usually considered to include the return of the affected community. (Emergency Management Australia, Evacuation Planning
(Manual Number 11), 2005)
Page 11 of 70
Business continuity planning template

This is a step-by-step guide for healthcare, health services and community services providers to plan and be prepared for an emergency or a pandemic.
Wider research/ consultation may be required to ensure your strategies and plans cover the unique needs/ circumstances of your organisation.
No one knows when an emergency, a crisis or a pandemic outbreak might occur or how severe it might be or what impact it might have on your normal
operations. In this way, planning for an emergency or a pandemic is like planning for an earthquake. The important thing is that you take the appropriate
steps now to protect your staff, volunteers, patient/ residents and third parties for potential adverse future events.
1. Getting started
Tick/ date
Turn this template/ worksheet into action plans to suit your particular circumstances
Wider research/ consultation may be required to ensure your strategies and plans cover the unique needs/ circumstances of your
organisation, business and operations.
Appoint a manager and deputy/ alternate
This will often be senior management staff. The manager will develop your organisations strategies and plans including outlining the primary roles and responsibilities of
key participants/ stakeholders within and external to the organisation. Please consult and communicated with key stakeholders - Board, Management, staff/ volunteers,
patient/ residents, carers, as necessary. Having a dedicated person who is going to be responsible for business continuity is vital to the long-term success of your BCM
program.
Name:
Contact no.:
Alt Contact no.:
Alternate name:
Contact no.:
Alt Contact no.:
Alternate name:
Contact no.:
Alt Contact no.:
Page 12 of 70
Basic information about your facility

This may be required for each facility managed by your organisation, if they are located in different geographical locations.
Name of facility, address, telephone number, emergency contact, telephone
and fax numbers, e-mail address
Owner of facility, address, telephone number, e-mail (if applicable)
Year of facility was built

Name of administrator, address, work/ home telephone number, e-mail (if
applicable)
Number of facility beds
Maximum number of patient/ residents on site
Average number of patient/ residents on site
Page 13 of 70
Type of patient/ residents served by the facility to include (but not limited to):
(1) Patient/ residents with Alzheimer/ Dementia, etc.
(2) Patient/ residents requiring special equipment or other special care, such as
oxygen or dialysis.
(3) Number of patient/ residents who are self-sufficient/ mobile/ independent
(4) Others
Type of geographical zone this site/ facility is located in

(1) Fire zone
(2) Flood zone
(3) Others
Page 14 of 70
Know your points of contact with your local DH/ DHS/ DOHA representative, essential services (like Victoria Police, State Emergency Services, Fire
Authority, and Ambulance Victoria), media and local council, etc.
Leading into an emergency/ a pandemic, you will need to identify who your correct point of contacts are and how to contact them on a 24X7 basis. Form strong
personal relationships with these external stakeholders.
Department of Health - regional or local office
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Department of Human Services - regional or local office
Victorian office of the Department of Health and Ageing (DOHA) - regional or local office
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Victoria Police - regional or local office
Fire Brigade/ Authority (MFB/ CFA) - regional or local office
Page 15 of 70
Ambulance Victoria/ Ambulance Control - regional or local office

Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Council regional, shire, municipal or local
State Emergency Service (VICSES) - regional or local office
Media/ ABC Radio/ newspapers - regional or local office
Others (Please specify) ________________________________________
Page 16 of 70
2. Working with your community of contacts
Tick/ date
Consult with and inform relevant stakeholders about your strategies and plans and what they can do to help. Take care not to cause
alarm.
Topics to cover include:
What your organisation is doing to prepare and plan?
What patient/ residents and families/ carers can do to prepare?
What you need from them so that they can assist in your planning, including what their roles and responsibilities would be?
Next steps.
Consider also how your organisation would communicate with staff/ volunteers, patient/ residents, etc. in later phases (especially recovery,
resumption and restoration).
Board Members/ Minister
Name:
Contact no.:
Alt Contact no.:
Name:
Contact no.:
Alt Contact no.:
Name:
Contact no.:
Alt Contact no.:
Hospital 1:
Contact no.:
Alt Contact no.:
Hospital 2:
Contact no.:
Alt Contact no.:
Hospital 3:
Contact no.:
Alt Contact no.:
Build links with the following agencies, community support networks, etc.
Nearest hospitals (private and public)
Page 17 of 70
Local doctors/ out-of-hours GP services

Doctor 1:
Contact no.:
Alt Contact no.:
Doctor 2:
Contact no.:
Alt Contact no.:
Doctor 3:
Contact no.:
Alt Contact no.:
Chemist 1:
Contact no.:
Alt Contact no.:
Chemist 2:
Contact no.:
Alt Contact no.:
Chemist 3:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 3:
Contact no.:
Alt Contact no.:
Nurse 1:
Contact no.:
Alt Contact no.:
Nurse 2:
Contact no.:
Alt Contact no.:
Nurse 3:
Contact no.:
Alt Contact no.:
Local chemist/ pharmacies
Local community hall/ civil centres/ neighbourhood houses
Local/ district nurses
Page 18 of 70
Local schools/ kindergartens

School/ kindergarten 1:
Contact no.:
Alt Contact no.:
Contact no.:
Alt Contact no.:
Contact no.:
Alt Contact no.:
Contact no.:
Alt Contact no.:
Build links with the following organisations/ dependencies - this should be linked to your contract management system, whereby a list of key contracts are
centrally maintained and kept updated
Power/ electricity provider
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Water provider
Gas/ medical gases provider
Page 19 of 70
Mobile/ back-up power generator provider

Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
IT/ Communication provider
Waste disposal/ sanitation provider
Tenant(s)
Voluntary/ community groups e.g. Red Cross, Rotary Club
Page 20 of 70
Financial institution/ bank(s) operations, investments, payroll

Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Name 1:
Contact no.:
Alt Contact no.:
Name 2:
Contact no.:
Alt Contact no.:
Insurers
Temporary staffing/ employment agencies
Food Supplier
Key Supplier: ___________________________________________
Page 21 of 70
3. Contact lists, roles/ responsibilities and resources
Tick/ date
Set up comprehensive emergency contact list(s) and update/ test it regularly

Attach the following emergency contact lists as Appendices to your plans.

Staff (full-time, part-time, etc,) home/ emergency contacts details (preferably having two emergency contacts) indicate if they
are willing to carry out alternative duties (for example, in health or welfare roles).
You may want to have a dedicated 1800 contact number for your staff/ volunteers to use exclusively to ring in and to
find out what is going on and what help they can provide (rather than using or overwhelming the general number)
Volunteers home/ emergency contacts details. Conduct all necessary regulatory pre-checks on volunteers before
including them on your emergency contact list.
Parents/ carers/ next-of-kin contact details - at least two local emergency contact details for each patient/ resident
Key supplier/ stakeholder contact details
What are the business rules to trigger the use of these emergency contact lists?
Process/ procedures to use these emergency contact lists? Pre-approved written messages/ script used?
Process/ procedures to verify that everyone (that requires to be contacted) on these emergency lists has been contacted and understands the
message/ instruction conveyed?
How often are these emergency contact lists updated/ checked/ reviewed? (at least once a year)
How often are these emergency contact lists tested/ checked/ reviewed? (at least once a year)
Page 22 of 70
Issues to consider Right people having the right information at the right time
4.
Establish a planning team
4.1.
Gain Board and/or Senior Management support and mandate to: (i) develop and maintain strategies and plans, and (ii) maintain
the BCM program in the long-term.
Support and mandate for the BCM program and strategies documented/ minuted?
Notes
Ensure Board/ Senior

Management understand the
pros and cons of advance
planning, developing and testing
strategies and plans, and
committing organisational
resources to the BCM program.
Be prepared and delegate
responsibility to others to help
during an emergency.
4.2.
Existence of command and control structure to provide governance, management and decision-making during an emergency/ a
pandemic? Process/ procedure to review command, control and coordination arrangements for each site/ location to ensure that
they are capable of being adapted and/or flexible to the needs of evacuation or shelter-in-place?
Same governance structure used for both the emergency management and business continuity programs?
Who is assigned to communicate with the media/ press and/or issue press releases?
What is the decision-making process during an emergency/ a pandemic?
Process/ procedure to document key decisions made during an emergency/ a pandemic?
Existing governance for your

command and control structures
should be optimally used.
Everyone involved should know
their exact roles and
responsibilities during an
emergency/ a pandemic.
Avoid duplicating governance
structures and roles, where
possible/ practical.
The CEO is generally assigned
to communicate with authorities,
media, etc.
All key decisions and facts
should be logged/ documented
and reported appropriately and
immediately. The appropriate
command, control and
coordination arrangements
should be established as soon as
is practicable after the event.
Who is responsible for documenting the facts/ sequence of events and/or key decisions made?
Page 23 of 70
4.3.
Notes
What emergency and evacuation plans (or similar) are currently in place?
Build on what the organisation

currently have and develop/ write
plans only to close any gaps
identified.
How effective are these plans? Perform a gap analysis to determine potential areas of improvements to close any gaps?
A full set of plans should be kept

off-site and assessable by key
staff, when required.
Where these plans are kept (preferably off-site) and how updated/ current are they?
Updated copies of diagrams (e.g.

engineering systems) and site
drawings (e.g. building plans)
should be kept off-site, securely
and safely, where possible.
Copies of updated key diagrams and site drawings kept off-site, in secure and safe location?
4.4
Are these strategies and plans classified as confidential/ organisational secrets and be made available on a need-to-know basis?
5.
Understanding your context
5.1.
Are your business continuity/ emergency management aligned: (i) within your organisations overarching risk management policy
and plan; and (ii) to your organisational objectives?
What is the maturity of your organisations risk management framework and process? Where are the gaps?
Unauthorised access may

expose your vulnerabilities.
Access to plans must be
restricted on a need-to-knowbasis and controlled as part of
the organisations information
security policy.
Notes
Business continuity and
emergency management
program is developed within a
broader organisational risk
management framework. Your
risk management framework is
the foundation for your business
continuity and emergency
management program.
Page 24 of 70
5.2.
Explore/ understand the organisations threshold for maintaining business-as-usual, based on the organisations risk appetite
(risk averse or risk taker) and operational circumstances.
Notes
There is no one-size-fit-all
solution to business continuity
and emergency management.
What is your organisations risk tolerance (based on risk management policy)?
5.3.
Is your facility part of a larger entity/ group?

Who do you need to talk to for incorporating your strategies and plans into a wider entity-level planning?
5.4.
Develop a common understanding of the level of threat or risks poses to your organisation/ facilities, especially for decision
making and establishing the required/ necessary business rules and triggers.
What are the top five (5) service continuity risks faced by your organisation/ operational site/ location/ facility?
Risk 1:
Risk 2:
Incorporate your planning into

the larger entitys overall plans,
ensuring that your organisation
has been considered as part of
that entitys overall planning
process.
As part of your planning, it is
imperative that a risk assessment
starts the process. Site specific
evacuation and shelter plans
should be informed by risks most
likely to impact the site and the
wider local area using relevant
resources. Within the site, this
should include the risks
associated with the location and
certain types of patient/ residents
(of this location) in relation to the
ease of evacuation/ relocation.
Risk 3:
Risk 4:
Risk 5:
Page 25 of 70
5.5.
What, where and/or who is your information source (e.g. radio (774 ABC Radio?), internet (Bureau of Meteorology, CFA, etc),
newspapers, etc.) - to include off hours and weekends/ holidays, on a 24/7 basis?
Organisations need to monitor

these authorised/ predetermined/ pre-approved
information sources for regular
updates or news.
Is the information source accurate, timely and/or complete?
During the course of an

evacuation/ relocation and
shelter-in-place event,
organisations will need to take
into account the need to maintain
communications to support the
process and the need to deal
with stakeholders.
If so, can the information be an input to your decision making process?

Do your communication framework/ process include all applicable stakeholders?
5.6.
Notes
What planning assumptions are you going to make when you develop your strategies and plans? Verify, test and challenge all
planning assumptions so that your strategies and plans are reasonable, relevant and/or appropriate, given: (i) your unique
operational constraints and environment, and (ii) the types of patient/ residents you have for each location/ facility.
Some possible assumptions-
Assumption 1:
Rely on local council busses

for evacuation to alternate
location.
Rely on XX to take over the
management of the
emergency (help will arrive).
Assumption 2:
Assumption 3:
Ambulance Victoria can

supply five ambulances
when called upon.
Staff absenteeism may
increase by xx% (flu
season).
Staff will show up for work,
regardless.
Assumption 4:
Key suppliers will be there

for us, regardless.
Assumption 5:
Page 26 of 70
5.7.
Identify and document triggers and/or business rules that would clearly help you decide whether to:
(1) Escalate information upwards (within your organisational and reporting/ communication frameworks)
(2) Activate the necessary plan(s)/ phases/ activities Includes who (title, not name) makes the decision to activate/ trigger the
plan? Who will make the decision, if this person is not available?
(3) Discharge non-critical patient/ residents (non-medically independent).
Notes
Use all-hazards, all agencies and
community-focused approach.
Reporting/ escalating framework
should minimise loss of timely/
accurate information flowing
within the organisation.
Pre-defined and pre-approved
triggers and/or business rules.
This would ensure clarity of roles
and responsibilities, and avoids
confusion and uncertainty during
an emergency/ a pandemic.
Available lead time may influence
the decision to evacuate/
relocate.
(4) Evacuate/ relocate patient/ residents to other alternate location(s) temperature, relative humidity, wind direction, wind
speed, wind change, etc.
(5) Stay and shelter-in-place.
Examine the space of a facility to

be used as a shelter-in-place and
ensure it meets your needs for
space, accommodations,
restrooms, and a kitchen. You
have a duty of care to provide a
safe and secure shelter-in-place.
Managing stakeholders
expectations are important to
ensure that your strategies/ plans
can be executed and meet all
necessary conditions and
requirements.
(6) Scale down services (provided the organisation is not an essential service provider).
a. Develop strategies and plans for reducing services to external parties.
b. Develop strategies and plans for notifying patient/ residents of changes to normal services.
.
Page 27 of 70
5.8.
Arrangements made with the following stakeholders as part of your planning process:
(1) Staff, volunteers?
(2) Patient/ residents/ carers/ families/ next-of-kin?
(3) Government/ authorities/ regulators Local, state, federal?
(4) Community, neighbourhood, NGOs/ NFPs?
Notes
Clarify obligations/ expectations
during the planning phase to
avoid misunderstanding/
confusion.
Do not wait to be told to
evacuate. Remember the youare-on-your-own (YOYO)
principle. You are on your own
until help arrives. In the
meantime, immediately after the
point of disaster, you must have
the necessary plans to succeed
(through careful planning), to
maintain your reputation and duty
of care, and to maintain your
ability to continuity operating
beyond the event. Total reliance
on external parties to help your
organisation to be resilient to
emergencies should be avoided
or minimised.
Community-centred approach/
focus - This is the level at which
some of the most meaningful/
effective activities take place.
Community participation in
decision-making, implementation,
and monitoring and evaluation of
plans increases the
appropriateness and successes
of an early recovery interventions
and response.
(5) Key suppliers?
Page 28 of 70
5.9.
5.10.
Site location maps and documents outlining the organisations structure are up-to-date and regularly reviewed?
Profile of your entire workforce and its impact of increased absenteeism on the delivery of critical services? Would your staff not
all come to work for various reasons?
Notes
Site/ location maps identifying

the location/ position of all
buildings/ capital assets.
List and location of all

tenants.
Colour-coded line drawings of

the distribution of key utilities,
dependencies, etc.
Distribution of all critical

services.
Links between services and

reporting structure.
Google Maps
geographical profile
Staff may not come to work if

they are required to take care of
their children, especially when
schools may be closed during a
pandemic. Consider:
Rosters.
Vacancy rates.
Casual staff.
On call capacity.
Annual leave liability.
Scheduled leave.
Rates of unplanned leave.
5.11.
Process/ procedure to detail your strategies and plans in patient/ resident contracts? Patient/ residents or responsible parties
understand and acknowledge these provisions?
Let the family know that the

patient/ resident may be
displaced for an undetermined
period of time.
Page 29 of 70
Notes
5.12.
Patient/ residents profile at each location/ facility?
Consider (1) acuity; (2) mobility;

(3) mental capacity; (4)
dependency high or low care;
medical condition (hypertension,
arthritis, heart disease, cancer,
dementia, cognitive impairment,
etc).
5.13.
Your obligations to third parties if you provide services to other organisations that is, you s a service provider to other
organisations/ third parties?
For example:
Linen.
Transport.
Home care, respite.
Meals, child care.
Where are copies of these supply contracts kept?
Supply contracts should include

provisions for non-delivery of
services by your organisation in
the event of an emergency/ a
pandemic (considered as force
majeure?)
Continuity/ emergency clauses included into these supply contracts?
Financials/ costing agreed and included into these supply contracts (especially in reference to an emergency/ pandemic)?
Page 30 of 70
5.14
Notes
What are the physical vulnerabilities for each site/ location/ facility you are managing?
Site/ location/ facility
1.
Physical Vulnerabilities/ Risk Assessment

(i)
(ii)
(iii)
(iv)
2.
(i)
(ii)
(iii)
(iv)
3.
(i)
(ii)
(iii)
Priorities?
Overhanging trees, bushes

surrounding your facility may
become fuel during the bush fire
season. Understand all physical
vulnerabilities affecting each
facility through a risk
assessment/ identification
process.
This is part of tree/ vegetation
management, fuel reduction.
Victorian Government
announced the following:
Residents will not need a
council permit to clear any
vegetation, including trees,
within 10 metres of their
house.
Lower-lying vegetation such
as shrubs and ''ground fuel''
will be able to be cleared up
to 30 metres from their
house.
Land owners will be
permitted to clear trees and
other vegetation up to four
metres either side of their
fence lines, provided they
have the consent of their
neighbour.
People will be allowed to
collect firewood ''as of right''
from roadside areas that
have been identified as
posing a high fire-risk area
targeted for planned burning
by the CFA.
Page 31 of 70
5.15
Notes
Determine that emergency and disaster management (particularly response) procurement requirements have been identified with
relevant solutions incorporated into:
(1) Procurement policies
(2) Financial delegations
(3) Contractual delegations
(4) Contracts with key suppliers
(5) Contracts with suppliers who could be important / critical to response and recovery plans
Page 32 of 70
5.16
Notes
Implications of a local and regional emergency / disaster been considered and strategies formalised to mitigate the impact?
Strategies to improve community resilience so that the community can plan their response in the event of an emergency?
Relevance of CFAs Community Fireguard?
Page 33 of 70
5.17
Notes
Process/ procedure to review the following documentation:

(1) Municipal Emergency Management Plans
(2) Municipal Fire Prevention Plans
(3) Township Protection Plans (CFA)
(4) Location of high risk bushfire zones
(5) Victorian Fire Risk Register
(6) Neighbourhood Safer Places
(7) Wildfire Management Overlay
Page 34 of 70
6.
Risk identification and analysis
6.1.
What is your duty of care (common law or statutory or legal) to provide a healthy and/or safe environment to:
(1) Staff, volunteers (at your own facilities/ locations and at all planned alternate locations/ facilities)?
(2) Patient/ residents/ carers/ families?
Notes
A principle of health and safety

protection is for employees,
other persons at work and
members of the public be given
the highest level of protection
against risks to their health and
safety that is reasonably
practicable in the circumstances.
(Occupational Health and Safety
Act 2004). Employers cannot
delegate accountability/ liability to
third parties.
Part 4.6, Quality of Care
Principles 1997, under the
section labelled Fire, security
and other emergencies specifies
the outcomes where
Management and staff are
actively working to provide an
environment and safe systems of
work that minimise fire, security
and emergency risks.
(3) Contractors, third parties, visitors, suppliers?
Page 35 of 70
6.2.
What are your key legal, regulatory and contractual requirements relevant for your operations/ facilities?
Do you have a compliance matrix?
6.3.
Notes
Having an updated compliance

matrix assist in determining key
compliance areas to be followed
in an emergency/ a pandemic.
Can you meet all of these obligations during an emergency/ a pandemic? Decision not to meet (fully/ partially) legal and
regulatory requirements must be endorsed, at least, by the Executive and/or CEO and/or Board?
Have open and frank discussions

with staff/ stakeholders on their
obligations. Staff can withhold
their services for whatever
reason during an emergency
(e.g. pandemic, bush fire).
Anticipated what increased services consumers/ third parties may require from you during an emergency/ a pandemic (e.g. as a
receiving facility)?
You may be asked to receive

additional patient/ residents from
other facilities.
If requested, collaborate with local agencies in making your facility available in local emergency response efforts. Can you cope
as a receiving facility, where there is a surge of patient/ residents from another facility? Are your inventories sufficient? Ability to
provide a home-away-from-home environment? Have process/ procedures in place to ensure that sufficient lead time is
communicated to you?
Clarify what cost is appropriate

for making your facility available
as the receiving location.
Do you have additional resources available ready to assist? Are cost of service delivery (and chargeable to other organisation)
agreed upon with the other organisation if your facility is made available to other third parties?
Page 36 of 70
6.4.
Notes
Identify your critical services and/or business processes, rank them in order of importance and determine their maximum
acceptable outage (MAO). Would your facility/ site have priority over other businesses in your locality (e.g. restoration of power
due to power blackout)?
Service/ Process
Ranking/ Criticality
MAO (Hours)
Use the criticality and

dependency worksheet, where
possible.
MAO is the maximum period of
time that critical business
processes (or services) can
operate before the loss of critical
resources affects operations
(HB221:2004).
Page 37 of 70
6.5.
Confirm existing written protocols, business rules and/or procedures for each of these critical activities/ functions.
Notes
Standard operational procedures
for critical services/ functions
should be developed. These may
include:
Criteria for establishing

emergency teams.
Information flows (drafting of

situation reports (SITREPS),
briefings, back-up of
information, etc.).
Development and
dissemination of public
information.
Human resource
management during an
Identify new ones, where gaps are found (after gap analysis).
6.6.
6.7.
Identify essential resources/ dependencies required to meet the demands of critical services and/or business processes. Where
matching criticalities/ dependencies are identified, determine their priorities and develop any action/ project plans required to
close any identified gaps. (Use the worksheet where possible/ practicable)
Validate and document the level of redundancy (excess capacity) for all of the key resources identified, if any.
Dependencies/ resources
include:
Staffing (capacity,
capability).
Utilities electricity, water,

sewerage, gas, etc.
Waste disposal.
Food, linen, etc.
Systems IT,
communication, payroll, etc
Lifts, physical access.
Inventories, supplies.
Air conditioning, heating,

etc.
By understanding your level of

excess capacity, you are able to
provide some buffer in the event
of an emergency/ a pandemic.
Page 38 of 70
6.8.
Understand significant inter-dependencies/ intra-dependencies between

Critical services
Critical business services/ processes
Other essential resources/ dependencies (e.g. IT depends on electricity)
Key personnel/ human resources required
Notes
This is to ensure that all
dependencies are managed
accordingly and appropriately.
6.9.
Identify single points of failure, where possible, for dependencies listed above. Conduct a walk through test/ review to determine
possible single points of failure, understanding its causes and risks.
A single point of failure is part of

a system which, if it fails, will stop
the entire or substantial part of
the system from working. For
example, lifts may not be linked
to emergency back-up power
generator and therefore, will not
operate during a major power
failure.
6.10.
Assess the appropriateness/ completeness of your preventative maintenance program and/or breakdown maintenance
procedures in order to manage essential resources/ dependencies.
All preventive/ contractors

services must be independently
verified to ensure that work is
actually done in accordance to
agreed service contracts. For
example, smoke alarms regularly
serviced by third parties.
Determine how long these arrangements could be maintained without ongoing support or maintenance.
6.11.
Identify the key personnel and/or core skills required to maintain critical services and/or business processes.
People with the right skills/

competencies should be
identified to ensure that critical
services and/or business
processes can adequately
function during emergencies.
Page 39 of 70
Notes
6.12.
Review your organisations risk register to understand which risks will impact on the continuity of critical services and/or business
processes.
Your risk register may reflect key

physical vulnerabilities impacting
the organisation.
6.13.
Identify potential financial and non-financial exposures and impacts, where possible/ practical.
Examples include:
Cash flow availability to
purchase additional supplies
or services.
Ability to meet increased staff
costs.
Ability of the switchboard/
reception to manage a
significant increase in internal
and external calls.
Food and fuel stores.
Theft of key supplies.
6.14.
Can service level agreements or contracts executed by the organisation be amended/ adjusted to allow for reduced services
during an emergency/ a pandemic?
Discuss contingencies with key

stakeholders as required and
document variations in contracts.
Flexibility to vary contractual
terms ensures that you are not in
breach of your contractual
obligations to third parties.
6.15.
Determine what level of staff absenteeism could be tolerated for critical services and/or business processes, before minimum
service is no longer possible.
Review this as part of an

employees conditions of
employment where staff should
attempt to come to work in an
event of an emergency/ a
pandemic, especially in the
interest of the organisation or as
a moral obligation to your patient/
residents.
Page 40 of 70
6.16.
Verify whether any services and/or business processes could be operated remotely using telephone, fax and e-mail/ internet,
where possible (e.g. administration work/ task). This is linked to your work-at-home policies.
How many users can concurrently log-on remotely into your IT network to perform work from home without crashing the system/
servers?
6.17.
Process/ procedure to continue paying staff for protracted absence from work, especially during a widespread emergency/
pandemic?
Which bank is handling your payroll payments/ processing?
Is manual and/or remote payroll process possible?
Notes
Staff can work from home if they
are unable to come to work for
whatever reason.
By understanding your IT system
limitations, you are able to pregrant the necessary remote
access to your staff, based on
position and/or operational need.
Pay your staff in whatever

circumstances, especially if you
want them to work in an
emergency and especially if it
over and above their normal job
requirements.
Pre-arrangements with your bank
is vital to ensure that your
workforce gets payed on time,
regardless. Remote payroll
processing capability may be
necessary. This may also require
access to your finance staff and
funding/ cash flow to make the
necessary payroll payments.
Is your bank aware of your strategies and plans in relation to payroll processing?
Who is authorised to instruct your bank to make the necessary payroll payments in the event of an emergency/ a pandemic?
What documentation is required for such approval (if it differs from business-as-usual processing)?
Page 41 of 70
7.
Development and activation
7.1.
Develop intuitive strategies to manage and/or mitigate the spread of disease and/or minimise further physical damage
(especially during a pandemic).
Notes
Strategies include:
Transfer or relocation
In principle agreement/
arrangement (sharing
resources)
Temporary/ manual
workaround (alternative to
relocating)
Change, suspend or
terminate services, function
or process
Insurance (reputation risk)
Page 42 of 70
7.2.
Notes
Management, staff/ volunteers and patient/ residents trained in all aspects of emergency management/ business continuity:
Consider the following:
(1) Escalation procedures, triggers/ business rules, etc.?
Clear understanding of
procedures/ business rules.
(2) Horizontal evacuation to another part of the same floor, but within the same building?
Understand the duration for

horizontal and vertical
evacuations for different
categories of patient/
residents.
(3) Vertical evacuation to different floors of the same building?

(4) Full scale/ whole site/ building evacuation to pre-designated assembly areas located outside the building, including managing
headcount and communications?
(5) Full scale relocation to alternate locations/ facilities, including transportation and alternate transport route selection?
(6) Stay and shelter-in-place?
(7) Talking/ interacting with the media/ press, local radio stations, etc.?
(8) Discharge of non-critical patient/ residents to their own home/ families?
(9) Dealing with the injured and/or the dead, including communications with next-of-kin/ families?
Basic strategy for the

evacuation of dependent or
very high dependency patient/
residents may be to move
them on their bed or in a
wheelchair, to a safer area on
the same floor.
Considerations will need to be
given to any requirements for
continuing treatment or care
e.g. high care, etc.
Each person must be
accounted for. If you have
more than one assembly
point, need to ensure
information is co-ordinated/
synchronised between all
assembly points for
completeness (headcount).
Do not assume staff/
volunteers know which
transportation mode and
route to take during a full
scale relocation.
Manage the media before
they manage you.
Emergencies can lead to loss
of life.
Page 43 of 70
7.3.
What information regarding emergency, evacuation and relocation procedures should be included in your orientation programs for
new staff, volunteers and/or suppliers?
Notes
Orientation programs are a good
way to ensure that all new staff,
volunteers and patient/ residents
have some relevant basic
information.
Are these procedures also communicated to your patient/ residents/ next-of-kin, especially when they first register? How often do
we need to update them with updated/ current information?
7.4.
Conduct education programs/ seminars on: (i) stress management; (ii) grief; and (iii) transfer trauma to staff, patient/ residents
and their facilities.
7.5.
Conduct community education and equipping patient/ residents and their families, carers and support services to develop and
know how to implement their own disaster management plan.
Process/ procedure to promote inclusion of patient/ residents and/or people with disabilities in all stages of planning?
7.6.
What support/ counselling/ welfare services are available to your patient/ residents and staff/ volunteers immediately after the
emergency (in-house or external), especially if there are emotional issues resulting from the emergency?
There is a need for inclusive

community education and
assistance to enable patient/
residents and/or people with
disabilities, their carers and
support services to develop and
implement their own emergency
management plan.
Physiological and emotional

impact on staff/ volunteer can
affect their work and ability to
continue working in the stressful
environment of emergencies,
especially when there is also a
shortage of staff. Consider up
skilling in-house staff as external
services may not be immediately
available.
Page 44 of 70
Notes
8.
Identification of alternate facilities
8.1.
Which alternate locations/ facilities have been identified, if stay and shelter-in-place is not appropriate? Are these alternate
locations/ facilities clearly documented in your plans?
Name of Alternate Facilities
Contact Person/ Number
Distance (KM)
Travel Time
1.
Do not leave the name and

location of alternate facilities
blank as to-be-advised (TBA) in
your plans.
When selecting a site, consider:
capacity
2.
power, sewerage and water

communication
3.
long-term availability
catering
4.
access/ egress
proximity to transport
8.2.
Process/ procedure for ensuring that the destination is appropriate to meet the needs of your patient/ residents?
Agreements and commitments

may not be honoured in times of
emergencies.
Process/ procedure for ensuring that these alternate facilities/ locations will still be available at the time of relocation?
8.3.
Process/ procedure in place to notify alternate locations/ facilities that a decision has been made to evacuate patient/ residents to
their facility? How much advance notice is required?
Early notification would assist

receiving facilities to make all
necessary preparations to their
operations to adequately cater
for your patient/ residents.
Page 45 of 70
8.4.
Notes
Which local, state and/or federal authorities/ agencies should be consulted in your decision to either (i) relocate the patient/
residents or (ii) stay and shelter-in-place? Contact names and numbers listed in your emergency contact list?
Contact Person/ Number
Organisation Name
1.
2.
3.
Who is authorised for making the final decision, whether to (i) relocate to another facility, or (ii) stay and shelter-inplace in existing facilities?
What are the ultimate triggers/ business rules for this decision to be made?
Trigger 1:
Assumptions?
Dependencies?
You have the sole responsibility

and accountability (duty of care)
to your staff, patient/ residents
and 3rd parties to maintain a
safe, secure and healthy
environment under all
circumstances. The test would be
what was reasonably practicable
in the circumstances (see
Occupational Health and Safety
Act 2004)
Ultimately, the CEO may be the
sole person who is required to
make this crucial decision. All
decisions made may carry legal
consequences, especially after
the event. As such, document all
key decisions made to avoid
disparity in facts and sequence of
events.
TIME IS OF ESSENCE! If you
wait too long to make the
decision, external help may not
be available and escape routes
blocked/ unavailable/ unsafe.
Trigger 2:
Assumptions?
Dependencies?
An evacuation/ relocation may be

triggered by a variety of causes.
These may include:
Heat wave/ climate change.
Infrastructure failure.
Fire (internal/ external).
Trigger 3:
Assumptions?
Dependencies?
Power or other utilities

failure.
Flooding (internal/ external).
Gas leak.
Page 46 of 70
8.5.
Notes
What written documentation confirms the commitment of these alternate locations/ facilities (e.g. an in principle agreement)? Is
the cost/ pricing agreed and documented?
Facility Name
Agreement (Y/N)
Cost Agreed (Y/N)
Lead Time to Notify
1.
Third parties may be prevented

themselves in fulfilling their
contractual obligations to you,
especially if the emergency is
wide scale, affecting large areas
or entire communities.
Challenges of receiving facilities
include:
2.
Mobilising staff/ volunteers

to care for incoming
evacuees.
Organising community
volunteers to welcome
evacuee patient/ residents.
3.
Providing a home-awayfrom-home.
Reducing transfer trauma
where possible.
4.
Minimising disruption to
patient/ residents of
receiving facility.
Paperwork of evacuee
patient/ residents.
Return transportation
(restoration, resumption).
Consider the length of time each patient/ resident may need to spend at these alternate location/ facility.
Consider road-blocks that may hamper your escape or movement to/ from your facility.
Consider registration procedures that may be imposed by authorities.
Page 47 of 70
9.
Resources for emergencies/ evacuations/ shelter-in-place
9.1.
What critical shortages of medicines, food and other supplies are anticipated during a prolonged emergency? Understand current
stock of consumables and explore options for accessing adequate supplies/ inventories that are vital for your critical services
and/or business processes. Consider the need to stockpile essential supplies in advance.
What are their contractual obligations to you?

Do your supplier contracts contain business continuity/ emergency management clauses? Suppliers have continuity plans?
9.2.
What resources/ equipment are required to move patient/ residents in the event of a (i) partial (lateral, vertical); and (ii) full-scale
evacuation/ relocation? Review evacuation routes in all buildings and ensure that staff are aware of them.
Where is this equipment stored/ kept? Is the area clearly marked for staff/ volunteer access during an emergency? By what
means can staff/ volunteer access this equipment on a 24/ 7 basis?
What staff/ volunteer training is provided in the use of this equipment?
Notes
Consider shortages of supplies

because of increased demand
during emergencies (i.e. cleaning
supplies, home-based services,
etc).
Evacuation can be a timeconsuming and resourceintensive process. As the number
to be evacuated rises, so does
the time and resources it will take
to carry out the entire evacuation
process.
Having the right/ proper
equipment operated by skilled
staff/ volunteers would greatly
assist in the evacuation/
relocation process.
Patient/ residents with restricted
mobility, patient/ residents who
use wheelchairs and patient/
residents confined to bed cannot
negotiate escape routes,
particularly stairways, unaided.
Patient/ residents under
medication may require staff/
volunteer assistance, and
patient/ resident who are
dependent on electrical/
mechanical equipment for their
survival cannot always be
disconnected and moved rapidly
without serious consequences.
Process/ procedure for maintaining inventory and maintenance schedule documentation for this equipment?
Page 48 of 70
9.3.
Are patient/ residents who require the use of this equipment clearly identified? If so, how - e.g. Care Plan, etc.?
Process/ procedure for ensuring that this information is regularly updated?
9.4.
In what order of priority (triage) or sequence people (patient/ residents included) are fully evacuated from buildings? (For
example, most critical evacuated first or least critical evacuated first)
Clear guidance developed about how to handle and deal with vulnerable/ medically dependent patient/ residents?
9.5.
Process/ procedure to secure site/ location/ premises, if required, when evacuating/ relocating? Lockdown procedure?
Notes
Regularly updating individual
patient/ resident records is vital
to ensure that key information
goes with your patient/ residents,
especially to the appropriate
alternate facility during
evacuation/ relocation.
Time is of essence. If you wait

too long, you may not have
enough time to evacuate/
relocate everyone, especially
when emergency services are
also stretched and/or the area is
becoming dangerous for anyone
to enter or pass through.
Because of the potential for risk
to evacuees during movement,
special attention should be paid
to planning for this aspect. All
appropriate risk control measures
should be considered.
Leaving your premise unsecured/

unattended may result in theft/
looting. A lockdown is the
process of controlling site
movement and access both
entry and exit of people around
building in response to an
identified risk, threat or hazard
that might impact upon the
security of patient/ residents,
staff and assets or, indeed, the
capacity of that facility to
continue operating.
Page 49 of 70
9.6.
How will you maintain each patient/ residents Care Plan during transportation and/or at the alternate location/ facility? Would it
be updated prior to relocation/ transfer?
Care plans and other relevant patient/ resident documentation in hard-copies? Or are they all electronic?
Process/ procedure in place to print off hard-copy documentation from computer/ IT systems regularly, e.g. end of week?
Minimum time taken to restore minimum IT services in your organisation, if there is full failure of IT?
9.7.
Ensure that each patient/ resident is clearly identifiable before, during and after transfer/ relocation? How would you undertake
the identification/ tagging process e.g. coloured wrist-band, tracking device, etc.? Name tags for your staff/ volunteers?
Before transfer:
Notes
For fully computerised
environment, develop operational
manual procedures of printing
out key information for each
patient/ resident so that it can
easily follow the patient/ resident
in the event of an emergency,
without full reliance on the IT
systems. Computers may not be
operating during an emergency
to facilitate any printing. The time
to restore IT systems is variable.
It is your responsibility to ensure

that all patient/ residents are all
accounted for during the
relocation process, during
transportation and at all alternate
locations/ facilities.
Consider the following:
During transfer:
After transfer:
Type of transportation
required, recommended
transferring and lifting
techniques, and staffing.
Fax the data sheets to the
receiving facility, if possible.
Also, ambulances will need
this information for transport.
Have identification bands for
all patient/ residents with
name, specific requirements,
etc. Put the family contact
name and number on face
sheet and identification
bands.
Have nametags for all staff.
Page 50 of 70
10.
Transportation
10.1.
What transportation resources have been identified (e.g. buses, vans, ambulance etc)?
Agreement in Place (Y/N)
Transportation Mode/ Organisation
Cost/ Pricing Agreed (Y/N)
1.
2.
3.
Consider disruptions to
transportation systems and/or the
inability of suppliers to fulfil their
obligations/ commitment to you
because of their own staff
shortages and/or disruptions to
transport routes. Do not rely
solely on one transportation
provider/ source and routes.
Written documentation/
agreement confirm the
commitment of transport
providers, ensuring that the
vehicles are readily available
when needed.
4.
10.2.
Notes
Transportation/ escape (safe) route identified?

Transportation/ Escape Route
Private/ Public Road?
Risk Assessment
1.
Transportation needs may vary

based on environmental
conditions e.g. road conditions
may have been altered by flood,
fire, etc.
2.
Do not assume that drivers know

how to get to your planned
alternate location/ facility.
3.
All vehicles should be fully

fuelled.
4.
Routes clearly marked/ colour-coded in your plans and/or documented in your plans? Develop maps/ locations of evacuation
routes and description of how to get to a receiving facility for transport drivers.
Page 51 of 70
Notes
10.3.
Transportation resources/ requirements meet the needs of your patient/ residents (e.g. supine, wheel chair etc)?
Identify and plan for special

needs patient/ residents such as
patient/ residents on dialysis and
oxygen, patient/ residents in
need of special lifting equipment,
etc.
10.4.
How long will it take to fully evacuate all patient/ residents to all alternate facilities? How long will each patient/ resident be in
transit?
Individual planning could be

done and documented in patient/
residents care plan. This is
linked to the prioritisation done
during the site evacuation
process.
Transportation/ Escape Route
Full Relocation (All residents)

Min. Time
Max Time
Ave. Travel Time per resident

Min. Time
Max. Time
1.
Issues to consider:
2.
Unavailability of buses
contracted to evacuate
patient/ residents.
Unreliability or lack of air
conditioning in alternative
transportation.
3.
Inadequate staff/ volunteers.

Longer-than-expected travel
times, which require staff to
ration food and water.
10.5.
4.
Failure to transport some

medications, oxygen
canisters and incontinence
supplies.
Given the profile of your patient/ residents, can they survive the relocation journey on the transportation selected? Would it cause
potential loss of life and/or substantial harm?
Dehydration, pressure sores

and travel related illnesses,
such as urinary tract
infections, experienced by
patient/ residents.
Process/ procedure for ensuring these agreements are kept current, especially in the event of a wide scale emergency/
pandemic?
Keep contracts regularly updated

and reviewed as part of your
organisations contract
management system/ process.
Page 52 of 70
Notes
10.6.
What resources/ supplies are required to care for patient/ residents during transit (relocation) e.g. blankets, water, medicines,
toileting facilities, continence supplies etc.?
Relocation may not be an option

if you cannot secure sufficient
resources/ supplies that would
accompany patient/ residents to
the alternate locations/ facilities
safely.
10.7.
Process/ procedure for the ongoing assessment of each patient/ residents transport needs, especially based on his/ her preexisting conditions?
Within buildings, escape routes

should not be obstructed by the
storage of combustible or other
materials likely to cause a hazard
or reduce the availability or
suitability of these internal
escape routes.
How these needs are communicated and documented (e.g. Care Plan) and by whom?
10.8.
Do you have enough competent/ skilled staff (and/or volunteers) to accompany patient/ residents during transit/ transfer/
relocation to all alternate locations/ facilities?
You need capacity (adequate

number of staff/ volunteers) and
capability (adequately skilled
staff/ volunteers) to assist in the
transfer/ relocation process.
What is the staff-to-patient/ resident ratio required in order to avoid breaching your duty of care and/or service obligations to these
patient/ residents?
10.9.
How will you maintain effective two-way communication during the evacuation/ relocation process?
Communication with each

transportation vehicle use is vital
to maintain safety of patient/
residents during transportation.
Page 53 of 70
Notes
11.
Evacuation destination (receiving facility/ location)
11.1.
Is there enough room for friends and/or family to visit your patient/ residents in the alternate location/ facility? Can you
communicate this information to the patient/ residents friends and family?
The receiving facility needs to be

able to cater for additional
visitors. Restrictions may apply
and needs to be managed
accordingly.
11.2.
Handover process for patient/ residents to receiving facility? What paperwork is required for evacuee patient/ residents?
Proper/ adequate handover is

vital to ensure the continuation of
care and preventing loss of
information. Patient/ residents
condition may deteriorate during
transportation and must be
documented.
11.3.
What resources/ supplies are required to care for patient/ residents in the alternate location/ facility, e.g. blankets, water,
medicines, toileting facilities, continence supplies etc.?
These have to be pre-determined

during your planning process to
ensure that the receiving facility
has adequate inventory of
required items/ supplies.
How will you obtain these necessary supplies for these alternate locations/ facilities?
11.4.
How will you maintain effective two-way communication with all alternate locations/ facilities?
Not everything needed may be

taken initially, such as
communication aids, mobility
aids, hearing aids, spectacles,
medicine, diapers, supplies, and
feeding pumps. May need to plan
for the need to gather up
supplies.
Frequent staff visits may be

required to all alternate locations/
facilities to ensure that your
patient/ residents are adequately
taken care off pursuant to their
Care Plan.
Page 54 of 70
Notes
11.5.
How will you obtain necessary supplies if you decide to stay and shelter-in-place?
Suppliers may not want to deliver

supplies if there are perceived
dangers to their staff.
11.6.
Have you discussed the evacuation and ongoing care of the sickest patient/ residents with hospitals/ healthcare providers in your
local area? Are local hospitals capable of accepting and treating the sickest of patient/ residents?
As the last resort, contact your

local hospital to receive/ accept
the most medically/ physically
critically patient/ resident.
11.7.
How patient/ residents needs are communicated and documented in the alternate location/ facility (e.g. Care Plan)?
Communications with all

alternate locations/ facilities are
vital to ensure that all staff and
patient/ residents are taken care
off.
11.8.
Process/ procedure for ensuring that your staff are available to care for patient/ residents at all of the alternate facilities?
Staff may not come to work

because they are caring for their
own family (who may have flu) or
protecting their own property
(from bush fires).
Page 55 of 70
12.
Family/ emergency contact notification
12.1.
Process/ procedure for notifying a patient/ residents emergency contact person of the:
(1) Actual emergency/ situation?
(2) Decision to evacuate and/or relocate to an alternate location/ facility?
(3) Decision to stay and shelter-in-place?
(4) Decision to discharge non-critical patient/ residents to their family/ next-of-kin?
Notes
Notify families of relocation plans

and provide families or patient/
resident representatives with the
name and address of the
receiving/ alternate facility.
Consider that families/ patient/
resident representatives may
need to also evacuate. Obtain
current information on where
families/ patient/ resident
representatives will be located
and their contact numbers.
Open, transparent and honest
communication is vital to ensure
that all stakeholders are kept
informed/ consulted.
Messages/ information must be
consistently communicated.
Who is the person(s) (title, not name) responsible for notifying patient/ residents emergency contacts?
Process/ procedure for creating a script to ensure the right information is communicated consistently, throughout the notification
process e.g. why, when, how, where?
What are the alternative means of notification should your primary communication system fail?
Page 56 of 70
12.2.
Process/ procedure to seek the patient/ residents consent to move him/ her to the alternate location/ facility in the event of an
emergency/ a pandemic?
How will you manage a patient/ resident who refuses to move to another location/ facility?
How will you respond to a family who refuses to allow you to move/ transfer/ relocate a patient/ resident?
Notes
Generally, each patient/ resident
of a patient/ residential care
service has the right:
To live in a safe, secure and
homelike environment, and to
move freely both within and
outside the patient/ residential
care service without undue
restriction.
To be treated and accepted
as an individual, and to have
his or her individual
preferences taken into
account and treated with
respect.
To have access to information
about his or her rights, care,
accommodation and any
other information that relates
to him or her personally.
See also the Victorian Charter of
Human Rights and
Responsibilities Act 2006.
12.3.
Process/ procedure for tracking the completion of notification/ calling to emergency contacts, next-of-kin?
This ensures that everyone has

been systematically contacted,
within the shortest possible time.
12.4.
Process/ procedure for identifying those patient/ residents who are unable to speak and/or make decisions?
Interpreters may be required.
12.5.
Process/ procedure for assigning staff (and volunteers) to care for these patient/ residents?
Staff resources may need to be

prioritised.
Page 57 of 70
13.
Room/ facility evacuation
13.1.
Process/ procedure in place to verify that rooms/ buildings have been fully evacuated?
13.2.
On site assembly areas been identified for building evacuation? Are these areas safe and secure?
Location of Assembly Area
Sheltered/ Safe (Y/N)
Risk Assessment
1.
Notes
Patient/ residents should not

remain outside for long periods at
evacuation assembly areas,
especially if the area is fully
uncovered from the elements
(e.g. sun).
2.
3.
13.3.
Process/ procedure to ensure that everyone is accounted for?
13.4.
Process/ procedure for informing Emergency Services (e.g. Fire Brigade) of this procedure?
14.
Transportation of records and supplies
14.1.
Are your records safe from fire, etc (total destruction)? What about floods (partial damage)?
You have a duty of care to

ensure that everyone is safe and
accounted for (head count
management).
Protection of records/ information

should be addressed in your
information security policy.
Page 58 of 70
Notes
14.2.
Process/ procedure for transporting medication administration records and other medical records/ documentation to all alternate
locations/ facilities?
This affects the quality of care

being offered at all alternate
locations/ facilities.
14.3.
How will you manage a patient/ residents care if medical records/ documentation are destroyed and/or become unavailable?
Hard-copies of key information

may be required for stand-by at
all times, so that manual
procedures can be instituted.
14.4.
How will confidentiality/ privacy of patient/ resident records/ information be maintained:
Victorias privacy law does not

prevent the Country Fire
Authority or other emergency
services from obtaining the
information they need to deal
with emergencies.
(i) In an emergency?
(ii) During transit/ relocation?
(iii) In the alternate locations/ facilities?
Process/ procedure to handle a request for personal information in an emergency situation?
IPP 2.1(d) allows use or

disclosure to occur where the
organisation reasonably believes
it is necessary to lessen or
prevent a:
Serious and imminent threat
to an individuals life, health,
safety or welfare; or
Serious threat to public
health, public safety or public
welfare.
Escalation process for dealing with such disclosures and a guide for determining who makes the disclosures, what information is
likely to be released, and to whom?
Page 59 of 70
14.5.
Process/ procedure for transporting patient/ resident-specific supplies/ medications to all alternate locations/ facilities?
How long would these supplies/ medications last (days)?
Check vendor agreements to ensure that the delivery of emergency supplies, food provisions, nursing equipment, and laundry
needs can be made to alternate locations/ facilities.
Notes
Send patient/ resident-specific
supplies/ medications on the
transportation buses with the
patient/ residents. Include an
emergency drug kit, hydration,
and snacks for the patient/
residents and staff.
Preferably a minimum of three
days supply is kept with the
patient/ resident, regardless of
where they go.
Your plans should cover all
identified alternate locations/
facilities.
14.6.
Process/ procedure for transporting patient/ residents Schedule 8 medications to all alternate locations/ facilities?

facilities.
14.7.
Process/ procedure in place to account for the transfer of Schedule 8 medications between alternate locations/ facilities?

facilities.
14.8.
Process/ procedure for ensuring that the information outlined in this section is regularly updated and/or tested?
14.9.
Where the information for transporting records and suppliers maintained/ documented/ kept (e.g. care plan)?
Page 60 of 70
15.
Human resource issues/ staff absences
15.1.
Understand all key legal and regulatory obligations (people-related) as employers.
Notes
Refer to your compliance matrix.

You may not be able to contract
out of your legal obligations as
employers.
15.2.
Develop strategies/ plans for maintaining health and safety of staff/ volunteers, patient/ residents and visitors, where appropriate,
especially during a pandemic and in compliance with the OHS principles of health and safety protection.
Strategies to protect staff/

volunteers and patient/ residents
include:
Restricting workplace entry.
Reinforce good personal
hygiene practices.
Adequate air conditioning and
ventilation.
Encourage high uptake of
annual staff influenza
vaccination (aim to build >
75% uptake of annual flu
vaccine pre-pandemic
period).
Provide personal protective
equipment (PPE).
15.3.
Explore strategies and plans for managing unplanned leave.
Unplanned leave creates

uncertainty in terms of your
capacity/ workforce planning.
Page 61 of 70
15.4.
Consider redeploying staff/ volunteers to ensure the continuation of critical services and/or business processes.
15.5.
Arrangements with temporary staffing agencies to obtain additional or replacement staff on a temporary/ ad-hoc basis?
Notes
Flexibility to move/ redeploy staff/
volunteers does remove the
pressure on other staff members.
Are these individuals fully trained and competence in your operating procedures and functions to perform the work adequately
and/or competently?
15.6.
Identify key leadership roles across the organisation and explore contingencies for managing individual absenteeism amongst this
group.
15.7.
Promote an environment in which staff/ volunteer who becomes unwell feel that they can stay at home until they are well.
It would be prudent to have

alternates for key positions within
the organisation. This is linked to
your organisations succession
planning.
Can you ask/ mandate your staff to stay home?
Page 62 of 70
15.8.
Establish appropriate human resource, remuneration and leave policies for staff that are unable to come to work, especially
during a pandemic. Consider the following situations:
(1) Infection.
(2) Quarantine/ social distancing (i) self imposed, and/or (ii) mandatory.
Notes
Your planning should include a
review of all applicable human
resource policies and
procedures. This also requires
the participation of your HR
Director or Manager (or
equivalent) during the planning
process.
(3) Caring for children/ family members.
(4) Unable to access child care/ staff support services.
(5) Unable to access transport due to restrictions in road access.
15.9.
Consider the need for increased staff/ volunteer support/ welfare services.
Counselling, employee
assistance program (EAP),
shortened shifts, meals,
transport, accommodation, onsite child-care
15.10.
Process/ procedure to manage the (i) deceased, and/or (ii) injured?
Handle this with sensitivity.
15.11.
Develop strategies/ plans for communicating new policies and/or support/ welfare services to staff/ volunteers.
This should be part of your

overall reporting/ communication
framework.
Page 63 of 70
15.12.
Process/ procedure to manage an influx of volunteers wanting to help? Where do they call in to? Who do they speak to?
Process/ procedure to maintain/ update a volunteers register?
Notes
A pre-checked stand-by
volunteers list would be preferred
to avoid the need to comply with
all regulations pertaining to the
use of volunteers during an
Keep in mind the Principles of
Volunteering
(www.volunteeringaustralia.org)
16.
Communication
16.1.
Develop a visitors management policy that would be activated during an emergency/ a pandemic.
Visitors may complicate your

response to an emergency/ a
pandemic.
Can you exclude visitors from your facility?
16.2.
Discuss with staff/ volunteers of: (i) possible health, safety and security issues; (ii) the potential for and impact of service stand
downs; and (iii) leave/ HR arrangements; if they are ill; or need to look after children or relatives; or cannot come to work for
whatever reason.
Staff must feel that their

immediate needs/ welfare are
adequately taken care off before
deciding whether to show up to
work in an event of an
Page 64 of 70
16.3.
Consider the use of various communication channels/ infrastructure:

(1) Internet/ Webpage/ e-mail?
(2) Fixed land telephone line/ fax?
Do you have at least one telephone at each site/ location/ facility (and at alternate locations/ facilities) that works if the telephone
system loses power and/or if it breaks?
Can your switchboard/ reception cope with a sudden influx of external and internal calls?
(3) Mobile phone/ SMS?
Notes
Not all communication channels
may be available during an
Alternate communication
channels need to be developed
in case your normal/ primary
communication channels/
infrastructures become
unreliable/ overloaded/
unavailable, for whatever reason.
Keep communication lines open
since people would be calling
you to seek information and
updates. Ensure that your
switchboard/ reception is
prepared to handle a sudden
influx of calls.
(4) Pagers?
Ensure staff/ volunteers have

mobile phones for
communication purposes.
(5) Walkie-talkies?
Emergency public information

capability includes:
(6) Face-to-face meetings/ briefings/ door-knocking?
A central contact facility
(7) Triple-0
A system for gathering,

monitoring, and disseminating
emergency information
(8) Community sirens

(9) Satellite phone
Pre-scripted information
bulletins
Method to coordinate and
clear information for release
Capability of communicating
with special needs
populations.
(10) Others?
Page 65 of 70
16.4.
Develop communication strategies/ plans that addresses: (i) different stakeholder groups (se below); (ii) different types of key
messages to be put across; (iii) possible approaches to be used (web sites, leaflets, information in different languages, etc.); and
(iv) distribution mechanisms/ channels to reach different targeted stakeholder groups.
(1) Staff/ volunteers/ unions
(2) Community/ NGOs
(3) Parents/ carers/ next-of-kin/ families
(4) Patient/ residents
(5) Key suppliers/ contractors
(6) Authorities/ DHS/ DOHA/ agencies
(7) Media/ radio/ newspapers

(8) Others
16.5.
Process/ procedure for contacting staff/ volunteers who have not reported to work (when they should) and/or may be ill/ sick?
Notes
Communication strategies/ plans
helps clarify roles and
responsibilities and ensure the
effective execution of plans.
Examples of key messages - The
organisation:
Has planned for an
emergency should it occur.
Will support patient/
residents, families and staff
wherever possible during an
emergency.
Has developed a planned
rationale for service closure,
should this become
necessary.
Has identified critical services
and patient/ residents, and
will deploy all available
resources to ensure these
services continue during an
emergency.
Has a range of strategies/
plans to keep everyone
informed.
Acknowledges that everyone
has a role to play during an
emergency everyone will
understand his/ her rights and
responsibilities.
Will work co-operatively with
government(s), other
agencies and local
communities.
Include this as part of your HR
policy, which shows that you care
as a responsible employer.
Who is responsible for making contact with your staff?
Page 66 of 70
Notes
16.6.
Establish a website where key messages/ information can be posted in a timely manner.
Use of technology must be

considered at all times, since it
does automate your response
efficiently. People may also have
difficulties getting through your
general line.
16.7.
Have pre-worded contingency statements/ messages prepared and pre-approved for delivery to the workforce/ staff.
Pre-approved, pre-worded press

releases/ messages will increase
your response times and
information accuracy and
consistency.
16.8.
Have grouped e-mail address lists and/or pre-recorded phone messages.
Pre-recorded telephone
messages can be inserted by
Telstra/ Optus immediately after
an event. People calling your
general telephone numbers can
be greeted with this pre-recorded
message that informs them of the
actual situation and any
instructions, if required.
17.
Test your plan and know when to activate it
17.1.
Process/ procedure to monitor and review plans continuously/ regularly?
Strategies and plans are not

static. It will be necessary to build
in an ongoing process of review
and updates for these strategies
and plans.
Page 67 of 70
17.2.
Review and test all strategies and plans, including working from home and relocation arrangements. Process/ procedure to get
management sign-off of these results and action plans to close identifiable gaps? When testing strategies and plans, please
include emergency contacts listed in Sections 1 and 2 above.
Consider the following questions:

(1) What did we set out to do in these testing and reviews?
Notes
As a start, consider a scenario
based desk-top review of your
strategies and plans, which also
includes key external
stakeholders. It is only with
testing and review of your
strategies and plans can be you
certain that it works and interoperates with each other from
both an organisational-wide and
a community-focus perspective.
Common Plan Elements.
(2) What actually happened and what was observed?

(3) Why did it happen (lessons learned)?
(4) What are we going to do next time?
(5) Process/ procedure for correcting deficiencies noted during these training/ testing/ review exercises?
Plans shall have clearly

stated objectives.
Plans shall identify functional
roles and responsibilities of
internal and external
agencies, organisations,
departments, and positions.
Plans shall identify lines of
authority for these agencies,
organisations, departments,
and positions.
Plans shall identify logistics
support and resource
requirements.
Plans shall identify the
process for managing an
incident.
Plans shall identify the
process for managing the
communication and flow of
information, both internally
and externally.
Page 68 of 70
17.3.
Process/ procedure to manage operational/ manual backlogs during the restoration and resumption stages?
Where can we get extra resources to complete all operational/ manual back-logs?
17.4.
Strategies/ plans in place to recover your business operations/ facilities/ sites (recovery phase)?
Notes
Generally, organisations have
strategies and plans to respond
to emergencies, but lack
strategies and plans to recover,
restore and resume the
operations/ business.
Recovery phase recover
interim/ partial services and/or
operations.
17.5.
Strategies/ plans in place to restore your business operations/ facilities/ sites (restoration phase)?
Do you have enough resources and/or cash-flow for this phase?
Process/ procedure to ensure that patient/ residents return to their original location/ facility when is safe to do so?
17.6.
Strategies/ plans in place to resume your normal business operations/ facilities/ sites (resumption phase)?
Do you have enough resources and/or cash-flow for this phase?
Restoration phase restore to

full service and operations.
Resumption phase
normalisation, back to business
as usual services and/or
operations.
Page 69 of 70

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KEY QUESTIONS TO ASK (AND HAVE ANSWERS TO).............................................................................. 11

Introduction to Business Continuity Management (BCM)

To be effective, we need to pay attention to the following principles1:

BCM is an important contributor to the overall organisational resilience.

BCM assists organisations to continue achieving its objectives.

Draft AS/ NZS5050:2009 BCM standard

Integrated BCM process

Monitoring & Review

The process for BCM is represented in the diagram on the right2.

Establishing the Context

Communication & Consultation

BCM is a cyclical risk management process as described in ISO 31000:2009 risk

Plan Activation & Deployment

Draft AS/ NZS5050:2009 BCM standard

Overlapping clusters of activities and plans

Risk management prevention and risk mitigation.

Response immediate management (in response to an

Recovery to recover interim/ partial services and/or

Restoration to restore to full service and operations.

Resumption normalisation, back to business as usual

Control and/or command governance structures that

Risk Mgt Prevention/

Risk management policy and plan an overarching

Corresponding to these activities are strategies and plans that

Development and testing of strategies and plans

Reviewing, maintenance, training and auditing of strategies and plans.

Criticalities and successes

Test the system and dependencies, and readiness of all stakeholders.

Exercise and review strategies and plans.

Specific planning steps

(2) Responsibility for recommending

(3) The rights of people to stay and

older people and disabled people

How prepared are you?

Action Plans/ Gaps?

1. Documented business continuity/ emergency management strategies and plans

Has your business ...

Action Plans/ Gaps?

Check your results

If your score is 10 or less

Key questions to ask (and have answers to)

Business continuity planning template

Alt Contact no.:

Alt Contact no.:

Alt Contact no.:

Basic information about your facility

Owner of facility, address, telephone number, e-mail (if applicable)

Year of facility was built

Number of facility beds

Maximum number of patient/ residents on site

Average number of patient/ residents on site

(3) Number of patient/ residents who are self-sufficient/ mobile/ independent

Type of geographical zone this site/ facility is located in

(2) Flood zone

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Department of Human Services - regional or local office

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