Information

  • Audit Title

  • Location Description

  • Location
  • Department(s) Effected?

  • Type of Drill

  • Conducted on

  • Prepared by

  • Personnel Present

Scope

Senario

  • An earthquake has struck in the New Madrid fault line in Northeast Arkansas. It's effects a strongly felt in the Central Arkansas area. Arkansas Children's Hospital experiences moderate structural damage and various utility failures.

Mission Areas

  • Prevention, Protection, Mitigation, Response

EM 02.02.01 Communications As part of its Emergency Operations Plan, the hospital prepares for how it will communicate during emergencies.

  • Did staff dial 88?

  • Did staff notify patients, family and visitors?

  • Was Administration notified?

  • Was Security notified?

EM 02.02.03 Resources & Assets As part of its Emergency Operations Plan, the hospital prepares for how it will manage resources and assets during emergencies.

  • Check box if applicable.

  • Compliant?

EM 02.02.05 Safety & Security As part of its Emergency Operations Plan, the hospital prepares for how it will manage security and safety during an emergency.

  • Does the department have an evacuation plan?

  • Was the evacuation plan followed?

  • Did staff go to a rally point and account for staff members?

EM 02.02.07 Staff As part of its Emergency Operations Plan, the hospital prepares for how it will manage staff during an emergency.

  • Did staff perform "Duck and Cover"?

  • Does staff have a plan to contact patients to reschedule appointments?

  • Did staff follow their plan to reschedule patients?

  • What steps were taken?

  • Did staff evaluate the need for additional staff?

  • Describe:

EM 02.02.09 Utilities As part of its Emergency Operations Plan, the hospital prepares for how it will manage patients during emergencies.

  • Check box if applicable.

  • Compliant?

EM 02.02.11 Patients As part of its Emergency Operations Plan, the hospital prepares for how it will manage patients during emergencies.

  • Did patients, family and visitors hide out, strike out or get out?

  • Were patients, family and visitors evacuated?

  • Were patients, families and visitors directed to a rally point?

  • Add media

  • Were patients, families and visitors accounted for?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.