Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Evacuation Date / Time

  • Select date

Evacuation Assessment

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

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

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

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

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

  • Were there sufficient wardens available to control the evacuation?

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

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

  • 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?

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?

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?

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?

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?

Evacuation Complete

  • Time all areas evacuated?

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

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.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.