BOULEVARD LA
WILSHIRE
WEST MEDICAL
TOWER
ASSISTANCE LIST
WWMT
SELF ID
CONSENT
People Who Need Assistance
Why This Form?
This form allows building occupants to voluntarily let us know if they might need extra help during an emergency evacuation. This could be due to a permanent or temporary condition, such as a disability, pregnancy, or any other situation that may make it harder to leave the building on your own.
Who Should Complete This Form?
If you have a condition—temporary or permanent—that might make evacuation challenging, we encourage you to fill out this form.
Privacy & Security:
Your information will only be used for emergency planning and response. The list will be securely maintained in the Management office.
Supporting Safety Together:
By filling out this form, you are helping us plan for emergencies and ensuring everyone’s safety.
Relevant Regulations:
California Code of Regulations (C.C.R.), Title 19, Section 3.09(d)(5) & (B):
Building owners/operators must keep a list of those who have disabilities or other conditions and their evacuation needs.
Los Angeles Municipal Code (L.A.M.C.), Section 57.408.8.5:
Emergency plans must include a list of individuals who voluntarily self-identify as needing assistance and the help they require.
Self-Identification Consent
THANK YOU
