Contingency Planning

Southwark Carers Emergency Plan Template

Carers Emergency Plan
The Carers Emergency Scheme enables you to make a plan as to how you would like the person you care for to be supported were you to experience an emergency. This plan gathers details of the person you care for and gives you the opportunity to name people that can be contacted in case of an emergency. Examples of emergencies might be: Your admission to hospital or other health needs which preclude you from continuing to provide care Family emergency such as a close relative being taken ill and requiring help
My name is
Prefix First Last
The name of the person I support is
Prefix First Last
They like to be called
Their address is
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Their date of birth is
Date Format: DD slash MM slash YYYY
The best contact phone number of them is
If you need to gain access to the property where the person I care for lives, a key is held by
If there is a key safe to gain access to the Cared for persons property the access code is

If I am not able to provide care, because of an emergency, please contact one of the following.

Name	Telephone

Please list contacts in order of preference.

My GP is Dr.
My GP Practice
The GP of the person I care for is
The GP Practice of the person I care for is
The pharmacist who usually dispenses the medication for the person I care for is:
specify address, contact number if possible

Information about the support needs of the person I care for:

Nature of illness/disability:	Brief details of medical history:

Cared for people often maintain they can care for themselves and everything is fine. If they are asked questions, can their replies generally be relied on?
- Yes
- No
The person I care for has the following ALLERGIC REACTIONS WHICH REQUIRE IMMEDIATE MEDICAL ATTENTION (e.g. nuts, penicillin):
The person I care for has the following BEHAVIOUR ISSUES, the best way to calm them down is, the best way to break them bad news is:
Medication
To help the person that may be providing replacement care, list all the medication taken by the person you care for, where it can be found, what time it should be taken and by what method (e.g with water, with food, or by injection) etc.
A dosette box* is prepared
- Yes
- No
A dossette box is a disposal plastic system for arranging your weekly medicines.At a glance you can see which pills to take, and when. Use of the dossette system reduces the risk of mistakes considerably.
The dosette box can be found:

List

Medication name	Where it is kept	Time to be taken	How to be taken

Daily tasks
To help the person providing replacement care, LIST THE THINGS YOU DO EVERY DAY FOR THE PERSON YOU SUPPORT. Start from first thing in the morning to last thing at night.
07:00
07:30
08:00
08:30
09:00
09:30
10:00
10:30
11:00
11:30
12:00
12:30
13:00
13:30
14:00
14:30
15:00
15:30
16:00
16:30
17:00
17:30
18:00
18:30
19:00
19:30
20:00
20:30
21:00
21:30
22:00
22:30
23:00
23:30
24:00
Through the night
Phone
This field is for validation purposes and should be left unchanged.

Find us

Southwark Carers
3rd Floor, Walworth Methodist Church,
54 Camberwell Road, London, SE5 0EW
View map and directions

Contact us

020 7708 4497

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Nearest tube: Elephant & Castle underground station (Northern and Bakerloo lines).

Nearest Railway Station: Elephant & Castle

Buses from Elephant and Castle: ask bus driver for Burgess Park. Bus numbers: 12, 171, 148, 176, 68, 484, 42, 40, 45