Evacuation Drill Report

• Conducted on

  Date

• Client Business Name

• Physical Address of Business
  Address

• Name and Surname of Company Representative

• Prepared by

• LabourNet Branch

PRIOR TO DRILL

• Type of Drill

• Alert Method

• Have fire fighter/s been trained and appointed?

  Yes

  No

  N/A

• Do fire fighter/s have identification?

  Yes

  No

  N/A

• Have first aider/s been trained and appointed?

  Yes

  No

  N/A

• Have assembly areas been designated and employees trained?

  Yes

  No

  N/A

• Are “emergency plans and procedures” displayed?

  Yes

  No

  N/A

• Are emergency contact details displayed?

  Yes

  No

  N/A

• Is there means of alerting all employees to evacuate the building?

  Yes

  No

  N/A

DURING THE DRILL:

• Did the employees evacuate the building immediately after the evacuation was initiated?

  Yes

  No

  N/A

• Was evacuation orderly and quick?

  Yes

  No

  N/A

• Were instructions given to move to the designated assembly points?

  Yes

  No

  N/A

• Did the fire fighter/s or emergency coordinator/s sweep the floor?

  Yes

  No

  N/A

• Were all restrooms, and offices checked?

  Yes

  No

  N/A

• Did fire doors operate correctly?

  Yes

  No

  N/A

• Did all employees use their nearest emergency exit points?

  Yes

  No

  N/A

• Was everybody continuously kept informed regarding the situation?

  Yes

  No

  N/A

• Was a communication system applied during the evacuation?

  Yes

  No

  N/A

DRILL INFORMATION

• Number of persons who were present during the drill

• Number of special needed employees who carried out horizontal evacuation drill

• Number of “Critical operation” employees who will carry out Ad hoc evacuation drill

AFTER THE DRILL:

• Were all employees and visitors accounted for?

  Yes

  No

  N/A

• Was the roll call list readily available at the assembly point?

  Yes

  No

  N/A

• Did the first aider present the first aid box/es at the assembly point?

  Yes

  No

  N/A

• Did all alarms work properly?

  Yes

  No

  N/A

• Was there any significant disruption of services?

  Safe

  At Risk

  N/A

• Did everyone remain outside the building and wait for further instructions?

  Yes

  No

  N/A

• Are staff members familiar with their assigned duties?

  Yes

  No

  N/A

• Evacuation Duration

• Observations

• Compliance Level

  Good

  Fair

  Poor

• Name and Surname of LabourNet Representative

  Sign

• Name and Surname of Company Representative

  Sign