Evacuation Drill Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Type of drill

• Start Time

• End time

Location of Drill

• Facility wide

• Building/Area

1.0 General

• 1.1 Public emergency responders notified of drill?

  Yes

  No

  N/A

• 1.2 Emergency plan followed?

  Yes

  No

  N/A

• 1.3 Evacuation / exit routes clear / marked?

  Yes

  No

  N/A

• 1.4 Disabled employee needs addressed?

  Yes

  No

  N/A

• 1.5 Employee complaints / suggestions gathered / addressed?

  Yes

  No

  N/A

2.0 Alarm Function

• 2.1 Heard in all areas?

  Yes

  No

  N/A

• 2.2 Distinctive?

  Yes

  No

  N/A

• 2.3 Operational (no time delays, stay on for necessary time, etc.)

  Yes

  No

  N/A

3.0 Evacuation

• 3.1 Orderly?

  Yes

  No

  N/A

• 3.2 Prompt?

  Yes

  No

  N/A

• 3.3 Complete (all areas checked?)

  Yes

  No

  N/A

• 3.4 Proper routes used?

  Yes

  No

  N/A

• 3.5 Alternate routes identified / used?

  Yes

  No

  N/A

• 3.6 Emergency exits unlocked / accessible?

  Yes

  No

  N/A

• 3.7 Traffic flow adequate?

  Yes

  No

  N/A

4.0 Roll-Call Procedures

• 4.1 Supervisor / managers fulfill assigned duties?

  Yes

  No

  N/A

• 4.2 Everyone in proper groups?

  Yes

  No

  N/A

• 4.3 Visitors accounted for?

  Yes

  No

  N/A

• 4.4 Employees not at roll-call accounted for?

  Yes

  No

  N/A

• 4.5 Roll-call conducted in a timely manner?

  Yes

  No

  N/A

• 4.6 Employees remained in assembly area until the all clear announced?

  Yes

  No

  N/A

• 4.7 Roll-call documented?

  Yes

  No

  N/A

5.0 Emergency Response Team

• 5.1 Communication adequate?

  Yes

  No

  N/A

• 5.2 Response time adequate?

  Yes

  No

  N/A

• 5.3 Roles / responsibilities fulfilled?

  Yes

  No

  N/A

• 5.4 Areas / equipment checked per plan?

  Yes

  No

  N/A

• 5.5 Drill assessed?

  Yes

  No

  N/A

6.0 Training

• 6.1 All employees knew roles / responsibilities?

  Yes

  No

  N/A

• 6.2 Shutdown duties carried out?

  Yes

  No

  N/A

• 6.3 Visitors escorted by employees?

  Yes

  No

  N/A

• Weather Conditions

• Problems Encountered

• Safety Coordinator

  Sign

• Manager / Supervisor

  Sign

General

• Check if complete.

• Tap to enter information

Alarm Function

• Check if complete.

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Evacuation

• Check if complete.

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Roll-Call Procedures

• Check if complete.

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Emergency Response Team

• Check if complete.

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Training

• Check if complete.

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