Culligan Emergency Evacuation Record

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• What was type of evacuation?

  Select Fire Flood Bomb threat Security threat Chemical Spill Serious injury Other

  • Fire
  • Flood
  • Bomb threat
  • Security threat
  • Chemical Spill
  • Serious injury
  • Other

• Was this evacuation planned?

  Yes

  No

• Where the emergency services contacted?

  Yes

  No

  N/A

• How long did it take to evacuate the facility (in minutes)?

• Who was involved in the evacuation?

  All colleagues

  Certain colleagues

• Which colleagues were involved?

• Where there any concerns?

  Yes

  No

• What concerns were raised?

  Select Inadequate egress Inadequate number of fire/ evacuation wardens Alarm issues Evacuation process not followed Other

  • Inadequate egress
  • Inadequate number of fire/ evacuation wardens
  • Alarm issues
  • Evacuation process not followed
  • Other

• Ensure an action is raised and details of the concern are included

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• Name and signature

  Sign