Title Page
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This form is used to record an evaluation of an Emergency Drill or actual event conducted at any CDC NSW location.
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Site conducted
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Conducted on
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Prepared by
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Location
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Site Manager
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Scenario?
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What is the Emegency?
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Is it a real event?
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Where Emergency Services involved?
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Which Services attended?
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Who attended?
2. Timeline
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Start: Alert signal (where formal occupant warning system used)
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Time Alert started
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Start time : Evac signal (or time alarm sounded)
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Time 90% of occupants reached assembly point
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Time 100% reached assembly point
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Time all clear advised to assembly point
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Overall duration of exercise (Mins)
3. Evaluation
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Was the alarm sounded?
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Was emergency response documentation up to date?
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Were all emergency response personnel present onsite?
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Were all emergency response personnel aware of their roles/ duties?
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Was it clear to participants where to go and/or what to do?
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Were any visitors or contractors involved in the evacuation?
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Were persons with disabilities taken into consideration?
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Was a debrief carried out?
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Record reasonspersonnel did not respond as per site Emergency Plan(if any).
4. Equipment
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Was all emergency equipment in operational condition?
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What was the issue with the equipment, attach photo if possible.
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Was the evacuation signal audible throughout the building?
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What was used for the audible signal?
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Were fire doors and emergency exits unobstructed?
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What was obstructing the exit? Attach photos.
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Was firefighting equipment utilized?
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What were the pieces that were used? Attach photos if easier.
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Had all emergency equipment been checked within required timeframes?
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Enter details of any equipment that did not function as per site Emergency Plan
5. Actions
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Where an issue is identified, use the actions provided to record actions to fix the immediate issue and address any systemic failures.
Note: All actions must also be recorded in the Improvement Register. Please ensure actions to revise Emergency Plans, where required, are included.
Actions
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Issues identified during evacuation
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Who needs to action this?
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When does it need to be actioned by?
Sign-Off
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Form completed by?
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Reviewed by Depot Manager?
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What is email address to send completed report too?
