Title Page

  • This form is used to record an evaluation of an Emergency Drill or actual event conducted at any CDC NSW location.

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Site Manager

  • Scenario?

  • What is the Emegency?

  • Is it a real event?

  • Where Emergency Services involved?

  • Which Services attended?

  • Who attended?

2. Timeline

  • Start: Alert signal (where formal occupant warning system used)

  • Time Alert started

  • Start time : Evac signal (or time alarm sounded)

  • Time 90% of occupants reached assembly point

  • Time 100% reached assembly point

  • Time all clear advised to assembly point

  • Overall duration of exercise (Mins)

3. Evaluation

  • Was the alarm sounded?

  • Was emergency response documentation up to date?

  • Were all emergency response personnel present onsite?

  • Were all emergency response personnel aware of their roles/ duties?

  • Was it clear to participants where to go and/or what to do?

  • Were any visitors or contractors involved in the evacuation?

  • Were persons with disabilities taken into consideration?

  • Was a debrief carried out?

  • Record reasonspersonnel did not respond as per site Emergency Plan(if any).

4. Equipment

  • Was all emergency equipment in operational condition?

  • What was the issue with the equipment, attach photo if possible.

  • Was the evacuation signal audible throughout the building?

  • What was used for the audible signal?

  • Were fire doors and emergency exits unobstructed?

  • What was obstructing the exit? Attach photos.

  • Was firefighting equipment utilized?

  • What were the pieces that were used? Attach photos if easier.

  • Had all emergency equipment been checked within required timeframes?

  • Enter details of any equipment that did not function as per site Emergency Plan

5. Actions

  • 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
  • Issues identified during evacuation

  • Who needs to action this?

  • When does it need to be actioned by?

Sign-Off

  • Form completed by?

  • Reviewed by Depot Manager?

  • What is email address to send completed report too?

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