Emergency Evacuation Drill (F-SHEQ-A.2-01)

NOTE: This form is ONLY to be completed by either the Chief Area Warden, Assistant Area Warden or an Area Warden.

• Document No.

• MRI Site

  MRI - ACT

  MRI - NSW

  MRI - QLD

  MRI - VIC

• Date Emergency Evacuation Drill Held

  Date

PRIOR TO THE EMERGENCY EVACUATION DRILL

• Do all Area's have a Fire Warden assigned?

  Yes

  No

  N/A

• What area's need a Fire Warden assigned?

• Have all assigned Area Fire Wardens been Trained?

  Yes

  No

  N/A

• Who still needs training?

• Do all Area Fire Wardens have Identifiable PPE (eg, Hard Hat or Cap, Coloured Vest, etc.)?

  Yes

  No

  N/A

• Who doesn't have Identifiable PPE and Why?

• Has an Assembly Areas been designated?

  Yes

  No

  N/A

• Why Not?

• Have all Employees been informed as to where the Assembly Areas is?

  Yes

  No

  N/A

• Why Not?

• Has the Site Emergency Plan (or Procedure) been displayed for access by all Staff and Visitors?

  Yes

  No

  N/A

• Why Not?

• Describe Emergency Evacuation Drill Scenario:

• Was there also a First Aid Scenario?

  Yes

  No

  N/A

• Describe the First Aid Scenario:

• Were all employees and guests accounted for?

  Yes

  No

  N/A

• Who was missing and why?

• Was the Missing Person part of the Emergency Evacuation Drill Scenario?

  Yes

  No

  N/A

DURING THE EMERGENCY EVACUATION DRILL

• Time the Evacuation Started?

  Date

• What alarm system was used?

• Was alarm heard throughout building?

  Yes

  No

  N/A

• What area(s) was the alarm Not heard?

• Did the alarm system function correctly?

  Yes

  No

  N/A

• What Happened? Why did the alarm not function correctly?

• Did all Employee's, Contractor and Visitor evacuate the Building as soon as the Alarm was Activated?

  Yes

  No

  N/A

• List who did not leave and why?

• Was evacuation orderly and quick?

  Yes

  No

  N/A

• List what happended

• Did ALL evacuated Personnel assembly in the designated Assembly Area?

  Yes

  No

  N/A

• List what happended

• Were instructions given move to another location because the Designated Assembly Point was not safe?

  Yes

  No

  N/A

• List where everybody evacuated to

• Were all areas checked (including Offices, Restrooms, Conference Rooms, Storage areas, etc)?

  Yes

  No

  N/A

• What area was Not Checked and Why?

• Did all Area Wardens check in with the Chief Area Warden?

  Yes

  No

  N/A

• Who did not check in with the Chief Area Warden and Why?

• How would you rate the overall total time of the Emergency Evacuation Drill went?

  Good

  Fair

  Poor

• How would you rate the Effectiveness of MRI Emergency Procedures during the Emergency Evacuation Drill?

  Good

  Fair

  Poor

• How would you rate the overall Communication during the Emergency Evacuation Drill?

  Good

  Fair

  Poor

• Was a Communication System used during the Emergency Evacuation Drill?

  Yes

  No

  N/A

AFTER THE EMERGENCY EVACUATION DRILL

• Did everyone remain at the Assembly Point, in an orderly fashion and wait for further instructions?

  Yes

  No

  N/A

• Time the "All Clear" was given?

  Date

• Time the Evacuation Was Completed?

  Date

• Who reset the Alarm?

COMMENTS / NOTES

• List any problems observed during the Emergency Evacuation Drill?

• Entre any Other Comments or Notes you might have:

COMPLETED BY

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Emergency Evacuation Drill Attendees

• I was present during the evacuation drill

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• Is there more personnel that attended the Emergency Evacuation Drill?

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  No

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  No

  N/A

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Please FORWARD (or email) this Completed Document to either; * The Operations Assistant, * Nicole Garaty for ACT & NSW, or * Tracy Bracken for QLD & VIC