To be effective in the event of an emergency evacuation, the University desires to be able to identify and support those faculty, staff, and visitors with a disability who need assistance in order to evacuate safely in time of need. If you are a person with a disability, even if you have not otherwise self-identified or asked for an accommodation, the University requests that you complete this form if you feel you need assistance in evacuating during an emergency.
Please complete the applicable sections of this form. The requested information will be kept on file by OEP, will not be kept in your personnel file, and will be used only to develop an emergency plan for you.
If you have any questions, please contact: The Office of Emergency Preparedness (OEP) at 706-542-5845, email: prepare@uga.edu. |
Functional Limitation (check all that apply)
*** Please complete each section that applies to you ***
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Auditory |
1. |
Do you use hearing assistance devices during the day?
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If yes, please describe
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2. |
During a normal day, if an emergency were to occur would you be able to hear the alarm and evacuate without assistance or special notification?
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If yes, please describe
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Visual |
1. |
Does your visual impairment prohibit or hinder your evacuation during an emergency?
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2. |
Do you use a cane or guide dog that helps you with travel throughout the day?
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