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


Print Your Name then Sign when completed
Attach or take Photos of Event if available
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.