Audit

Document Control
Location Photo

Company Undertaking Exercise/Drill

On behalf of (company/organisation)

Site Manager or Site Co-ordinator or Site Responsible Person

Distribution List (Name, Job Title and Email)

Distribution: Other

Exercise Observers

Other Observers

Part 1. Evacuation Stages and Times.

This section is to record the approximate evacuation time:

1. Initial evacuation from the danger zone
2. To Relative Safety
3. To Total Safety
4. To Dispersal Point

Primary Event

Relevant Emergency Service Contacted Pre and Post Exercise?

List of Emergency Services Contacted regarding Exercise

Danger Zone Evacuation Time

Evacuation: To Relative Safety

Evacuation: To Total Safety

Evacuation: To Dispersal Point

Part 2. Health and Safety: Pre and Post exercise location review

Is the location safety from a H&S view point for the exercise to be undertaken?

As a result of the exercise where any injuries report whilst on location?

Part 3. Equipment

Smoke machine, doors locked/tapped off with and observer next to this exit, role play etc

Was the smoke machine used as part of the evacuation exercise?

Was a loud hailer used as part of this evacuation exercise?

Where any exits or doors blocked off or locked as part of the exercise?

Part 4: Significant Findings and Recommendations - Following this Evacuation Exercise.
Items

Item 1

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 2

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 3

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 4

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 5

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Item 6

Priority Rating:

Location

Nature and brief description:

Action required - Interim (if required) and final action to rectify:

Person responsible for action:

Target Date for completion:

Status and Date - Complete or On-going

Part 5. Conclusion and Safety Rating
Current Site/Building/Ward/Unit Fire Risk Rating

Conclusion It can be concluded that with the implementation of the recommendations within the timescales provided as found in the Part 4: Significant Findings and Recommendations - Following this Evacuation Exercise and the continued support of BHFT Compliance and Risk Services Team, the occupants of the building are working within a safe environment that is broadly compliant with the Regulatory Reform (Fire Safety) Order 2005. It must be noted if the recommendations are not implemented within required timescales, persons within the exercised location and adjacent building/department/ward/unit will be at a greater life risk should a fire incident occur.

Document Recieved:
Received by local responsible person / representative
Exercise Report completion date:
Auditors Signature
Pictures
Next Evacuation Exercise Review
Recommended date for Exercise/Drill Re-Assessment
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.