Emergency Evacuation Practice Observer Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Emergency Details

• Type of Emergency

  Select Fire/Smoke Medical Emergency Bomb Threat Infrastructure/Internal Emergency Personal Threat External Emergency Evacuation Practice

  • Fire/Smoke
  • Medical Emergency
  • Bomb Threat
  • Infrastructure/Internal Emergency
  • Personal Threat
  • External Emergency
  • Evacuation
  • Practice

• Start Time

  Date

• End Time (time all persons are at assembly point)

  Date

Warden's Report

• Name of Warden on duty

• Work Area/s Checked with Sweep

• Area Clear?

  Yes

  No

  N/A

• Please provide details.

• All staff present at assembly area?<br>

  Yes

  No

  N/A

• Give Details and Reasons why staff at work were not present at Assembly Point.

• Attach Roll Call - Take Photo Here

  Media

• Evacuation of Mobility Impaired/Injured Persons (number and locations)

• Unwilling Persons (number and locations)

• Other

Emergency Services

• Required?

  Yes

  No

  N/A

• Type Required?

  Fire Brigade

  Ambulance

  Other

• Brief Incident Details

• Time Arrived on Site

  Date

Re-Entry

• All clear Given

  Yes

  No

  N/A

• By Whom

• Select date

  Date