Emergency Response And Evacuation Evaluation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Type of emergency scenario to be portrayed:

1.0 General

• 1.1 If using outside agency in the drill were they notified before hand and did they respond in a reasonable time?

  Yes

  No

  N/A

• 1.2 Was level of command followed and incident leader identified either formally or informally?

  Yes

  No

  N/A

• 1.3 Was an appropriate plan in place for the emergency scenario that was portrayed?

  Yes

  No

  N/A

• 1.4 Does staff seem to be oriented to the emergency plan?

  Yes

  No

  N/A

• 1.5 Did the event increase awareness and response to emergency scenarios?

  Yes

  No

  N/A

• 1.6 Were employee complaints and suggestions gathered as feedback and then addressed?

  Yes

  No

  N/A

2.0 Alarm Function

• 2.1 was the alarm heard in all areas of the site?

  Yes

  No

  N/A

• 2.2 is the sound of the alarm distinctive to other noises on site?

  Yes

  No

  N/A

• 2.3 Was the alarm functional - no delays starting it and it stays on for an appropriate length of time?

  Yes

  No

  N/A

3.0 Evacuation

• 3.1 Did all employees react to the alarm in an appropriate manor and evacuate in an orderly fashion?

  Yes

  No

  N/A

• 3.2 Was the evacuation prompt?

  Yes

  No

  N/A

• 3.3 was evacuation complete (all areas checked)

  Yes

  No

  N/A

• 3.4 appropriate routes for evacuation identified and followed?

  Yes

  No

  N/A

• 3.5 Alternate evacuation routes identified and used?

  Yes

  No

  N/A

• 3.6 Emergency exits are accessible and not blocked?

  Yes

  No

  N/A

• 3.7 Traffic flow adequate and well planned?

  Yes

  No

  N/A

4.0 Role-call

• 4.1 supervisors/managers fulfil assigned roles adequately?

  Yes

  No

  N/A

• 4.2 All employees in appropriate groups?

  Yes

  No

  N/A

• 4.3 All visitors are accounted for?

  Yes

  No

  N/A

• 4.4 Staff not at role-call accounted for?

  Yes

  No

  N/A

• 4.5 Role-call completed in a timely manor?

  Yes

  No

  N/A

• 4.6 Employees remain in the assembly area until the all clear signal is given?

  Yes

  No

  N/A

• 4.7 Role-call is documented?

  Yes

  No

  N/A

5.0 Emergency Response Team (ERT)

• 5.1 Communication is adequate?

  Yes

  No

  N/A

• 5.2 Response time was adequate?

  Yes

  No

  N/A

• 5.3 Roles and responsibilities reasonably fulfilled?

  Yes

  No

  N/A

• 5.4 Areas and equipment (plant) checked per plan?

  Yes

  No

  N/A

• 5.5 Emergency drill assessed by ERT and management?

  Yes

  No

  N/A

6.0 Rescue

• 6.1 Need for rescue is assessed quickly and area checked for additional hazards before beginning rescue?

  Yes

  No

  N/A

• 6.2 Appropriate rescue equipment available for the type of rescue being performed?

  Yes

  No

  N/A

• 6.3 Need for outside resources recognised in an acceptable time frame?

  Yes

  No

  N/A

• 6.4 Rescue techniques used are appropriate for the scenario being ran?

  Yes

  No

  N/A

• 6.5 Does rescue plan seem adequate and take into account contingency plans?

  Yes

  No

  N/A

7.0 Training and Preparedness

• 7.1 Employees knew their roles and responsibilities and acted accordingly?

  Yes

  No

  N/A

• 7.2 Shutdown duties carried out? (Plant and equipment, office fixtures, etc)

  Yes

  No

  N/A

• 7.3 Visitors escorted by employees?

  Yes

  No

  N/A

8.0 Additional Information

• 8.1 Weather conditions:

• 8.2 What went well?

• 8.3 What problems were encountered?

• 8.4 What opportunities for improvement are there?

Acceptance

• Sr Project Manager Fonterra

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• Project Manager LCI

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• HSE Manager LCI

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• HSE Officer Teamworkx

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