Emergency Evacuation & Exercise Debrief Form

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Type of event

  Emergency

  False Alarm

  Exercise

• Debrief Attendees:

• Floor / Area evacuated:

• Did Emergency Services Attending Event:

  Yes

  No

EVACUATION SEQUENCE:

• Alarm sounded

  Date

• Wardens respond

  Date

• Wardens check floor or area

  Date

• Evacuation commenced

  Date

• Wardens report floor or area clear

  Date

• Persons with disabilities accounted for

  Date

• Arrive at assembly area, safe place

  Date

• Wardens check personnel present (where appropriate)

  Date

• Evacuation completed

  Date

• Exercise terminated

  Date

QUESTIONS:

• (where the response to any of these questions is ‘Yes’, provide details in the ‘Comments’ section and ensure that corrective actions are entered into the Hazard and Corrective Actions Register and completed)

• Were there persons who refused to leave?

  Yes

  No

• Were there persons who returned before clearance?

  Yes

  No

• Did any elements of the Emergency Plan fail?

  Yes

  No

• Were any procedures found to be deficient?

  Yes

  No

Emergency Planning Committee Meeting:

• What elements of the Emergency Plan worked well and what did not

Acknowledgement

• CHIEF WARDEN:

• SIGNED:

  Sign

• DATE:

  Date