Emergency Evacuation Record & Debrief

• Site conducted

  Select

• Document Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• You must complete at least one evacuation drill per year.

• Type of Evacuation:

  Planned Drill

  False Alarm

  Real Event

• Location/Building:

  Select

• Attendees

  Select

• Manager (Fire Warden):

  Select

• Supervisor (Deputy Fire Warden)

• Pre evacuation Checklist (for scheduled drills)

• Did the Building Manager, Supervisor or Warden attend the pre-evacuation briefing?

  Yes

  No

  N/A

• All Manager, Supervisor or wardens identified e.g. red hard hat

  Yes

  No

  N/A

Evacuation Sequence

• Time the alarm was raised?

  Date

• Manager, Supervisor or Warden(s) response

• Did the Manager, Supervisor or Warden check of floor or area?

  Yes

  No

  N/A

• Why not?

• Did the Manager, Supervisor or Wardens report floor or area clear?

  Yes

  No

  N/A

• Why not?

• Were all persons with disabilities accounted for?

  Yes

  No

  N/A

• Did everyone arrive at assembly point or safe place?

  Yes

  No

  N/A

• Why not?

• Did the Manager, Supervisor or Wardens check personnel present (where appropriate)

  Yes

  No

  N/A

• Why not?

• Evacuation complete

  Yes

  No

  N/A

• Why not?

  Yes

  No

  N/A

• Exercise terminated

  Yes

  No

  N/A

• Debrief – to be completed to address issues arising from the evacuation

  Pass

  Fail

  N/A

• Signature

  Sign