AAAA Emergency Evacuation Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Evacuation Date / Time

• Select date

  Date

Evacuation Assessment

• Were all parts of the site evacuated?<br>

  Yes

  No

  N/A

• Did all person on site evacuate as required by the Emergency Evacuation Plan. Provide names of all persons who refused to evacaute.

  Yes

  No

  N/A

• Were the evacuation alerts/tones able to be heard throughout the site?

  Yes

  No

  N/A

• Were evacuation routes, exit doors or stairs, free from obstructions?

  Yes

  No

  N/A

• Were the people who required assistance, evacuated safely and timely?

  Yes

  No

  N/A

• Were there sufficient wardens available to control the evacuation?

  Yes

  No

  N/A

• Were the wardens easily identifiable? Were the wardens they wearing their helmets? (If not – note who and from what floor)?

  Yes

  No

  N/A

• Did the Area Warden check in with the Chief Warden and advise the status of their areas?

  Yes

  No

  N/A

• Were there any deficiencies noted during the evacuation?

Evacuation Times

• Time Alarm Raised?

• Time Chief Warden Arrived at Gatehouse?

Area A

• Wardens Name:

• Number of People In Area? / Number of People Evacuated? / Number of People Missing? /. /. .

• Time area evacuation compled?

• Were all people in the area accounted for? If not, what actions were taken?

  Yes

  No

  N/A

Area B

• Wardens Name:

• Number of People In Area? / Number of People Evacuated? / Number of People Missing? /. /. .

• Time area evacuation compled?

• Were all people in the area accounted for? If not, what actions were taken?

  Yes

  No

  N/A

Area C

• Wardens Name:

• Number of People In Area? / Number of People Evacuated? / Number of People Missing? /. /. .

• Time area evacuation compled?

• Were all people in the area accounted for? If not, what actions were taken?

  Yes

  No

  N/A

Area D

• Wardens Name:

• Number of People In Area? / Number of People Evacuated? / Number of People Missing? /. /. .

• Time area evacuation compled?

• Were all people in the area accounted for? If not, what actions were taken?

  Yes

  No

  N/A

Area E

• Wardens Name:

• Number of People In Area? / Number of People Evacuated? / Number of People Missing?

• Time area evacuation compled?

• Were all people in the area accounted for? If not, what actions were taken?

  Yes

  No

  N/A

Evacuation Complete

• Time all areas evacuated?

• Have all employees on site been accounted for? If not, what actions have been taken?

  Yes

  No

  N/A

All Clear

• Time evacuation "all clear".

Post Evacuation (Prior to debrief)

• Post Evacuation: Are there any additional opportunities to improve?

Evacuation Debrief

• Debrief Attendees:

• Positive Observations.

• Opportunities to Improve.

• List any actions identified in the debrief ( Person Responsible & Due Date). 1. 2. 3. 4. 5.