Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Enter Event Name

  • Enter Date & Time of Event

Disaster Drill Evaluation

  • Did employees respond appropriately when alerted?

  • Were patients and visitors correctly informed of the emergency?

  • If involved calling in outside agency (i.e.: gas, phone, water, police, fire dept.) did they respond quickly?

  • Did in-house Plant Services respond appropriately?

  • Were all staff moved to an appropriate location?

  • Were all patients / visitors accounted for?

  • Was the level of command followed and the incident leader identified either formally or non-formally?

  • Was there a plan in place for handling this emergency?

  • Is staff oriented to plan?

  • Did this event succeed in increasing awareness and response to emergency situations?

Disaster Drill After Action

  • Enter any opportunities noted during the event

  • Enter Corrective Action Taken

  • Comments

  • Print Your Name then Sign when completed

  • Attach or take Photos of Event if available

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