Disaster Drill

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Enter Event Name

• Enter Date & Time of Event

  Date

Disaster Drill Evaluation

• Did employees respond appropriately when alerted?

  Yes

  No

  N/A

• Were patients and visitors correctly informed of the emergency?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Did in-house Plant Services respond appropriately?

  Yes

  No

  N/A

• Were all staff moved to an appropriate location?

  Yes

  No

  N/A

• Were all patients / visitors accounted for?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is staff oriented to plan?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Disaster Drill After Action

• Enter any opportunities noted during the event

• Enter Corrective Action Taken

• Comments

• Print Your Name then Sign when completed

  Sign

• Attach or take Photos of Event if available

  Media