Enter Event Name
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?
Enter any opportunities noted during the event
Enter Corrective Action Taken