City of Palmerston Worksite Visit - Evacuation observation - duplicate

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Evacuation data

• Briefing time

  Date

• P.A Announcement

  Date

• Alert time

  Date

• Evacuation time

  Date

• All clear

  Date

Wardens

• Chief fire warden

• Front area warden

• Back area warden

• Ground floor fire warden

Area cleared

• Work area

  Civic Plaza

  Library

• Civic Plaza Ground floor area clear

  Yes

  No

  N/A

• Civic Plaza First floor back area clear

  Yes

  No

  N/A

• Civic Plaza First floor front area clear

  Yes

  No

  N/A

• Library area cleared

  Yes

  No

  N/A

General observations

• PA loud and clear

  Yes

  No

  N/A

• Occupants evacuated building in an orderly manner.

  Yes

  No

  N/A

Fire service representative

• Representative

Recommendations

• Recommendations:

• Signature

  Sign