Evacuation Exercise V1

• Document No.

• Department/Unit/Ward Location

• Conducted on

  Date

• Auditor

  Select Lloyd Smith Jill Griffiths Kellie Wilden Matt Kino-Wylam Mike Craissati Darryl Stevens Bernice Baverstock Matt Watts

  • Lloyd Smith
  • Jill Griffiths
  • Kellie Wilden
  • Matt Kino-Wylam
  • Mike Craissati
  • Darryl Stevens
  • Bernice Baverstock
  • Matt Watts

• Reviewer

  Select Lloyd Smith Jill Griffiths Kellie Wilden Matt Kino-Wylam Mike Craissati Darryl Stevens Bernice Baverstock Matt Watts

  • Lloyd Smith
  • Jill Griffiths
  • Kellie Wilden
  • Matt Kino-Wylam
  • Mike Craissati
  • Darryl Stevens
  • Bernice Baverstock
  • Matt Watts
• Site Location
  Address

Document Control

• Location Photo

  Media

• 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)

  Select Julian Emms, CEO for BHFT - julian.emms@berkshire.nhs.uk David Townsend, BHFT Board Level Director responsible for Fire Safety - david.townsend@berkshire.nhs.uk Christian Haw, BHFT Operational Estates Manager - christian.haw@berkshire.nhs.uk Nigel Lloyd, BHFT Senior Estates Manager - nigel.lloyd@berkshire.nhs.uk Property Information Administrator & Site Co-ordinator - anne.hamilton@berkshire.nhs.uk Local Responsible Person, see section responsible/Competent Person/s - Distributed to by the Fire Safety Team. Owner/Landlord, see section Responsible/Competent Person/s - Distributed to by Property Information Administrator & Site Co-ordinator Nikki Kirk, BHFT PFI Performance Manager - nikki.kirk@berkshire.nhs.co.uk Trish Day, BHFT Facilities Liaison Manager - trish.day@berkshire.nhs.uk Ifor Sheldon, SGP Contracts Manager - ifor.sheldon@sgp.co.uk Darryl Stevens, Compliance and Risk Services Team Manager - darryl.stevens@berkshire.nhs.uk Phil Watkins, Head of Compliance and Risk Services - philip.watkins@berkshire.nhs.uk

  • Julian Emms, CEO for BHFT - julian.emms@berkshire.nhs.uk
  • David Townsend, BHFT Board Level Director responsible for Fire Safety - david.townsend@berkshire.nhs.uk
  • Christian Haw, BHFT Operational Estates Manager - christian.haw@berkshire.nhs.uk
  • Nigel Lloyd, BHFT Senior Estates Manager - nigel.lloyd@berkshire.nhs.uk
  • Property Information Administrator & Site Co-ordinator - anne.hamilton@berkshire.nhs.uk
  • Local Responsible Person, see section responsible/Competent Person/s - Distributed to by the Fire Safety Team.
  • Owner/Landlord, see section Responsible/Competent Person/s - Distributed to by Property Information Administrator & Site Co-ordinator
  • Nikki Kirk, BHFT PFI Performance Manager - nikki.kirk@berkshire.nhs.co.uk
  • Trish Day, BHFT Facilities Liaison Manager - trish.day@berkshire.nhs.uk
  • Ifor Sheldon, SGP Contracts Manager - ifor.sheldon@sgp.co.uk
  • Darryl Stevens, Compliance and Risk Services Team Manager - darryl.stevens@berkshire.nhs.uk
  • Phil Watkins, Head of Compliance and Risk Services - philip.watkins@berkshire.nhs.uk

• Distribution: Other

• Exercise Observers

  Select Lloyd Smith Jill Griffiths Kellie Wilden Matt Kino-Wylam Mike Craissati Darryl Stevens Bernice Baverstock Matt Watts

  • Lloyd Smith
  • Jill Griffiths
  • Kellie Wilden
  • Matt Kino-Wylam
  • Mike Craissati
  • Darryl Stevens
  • Bernice Baverstock
  • Matt Watts

• 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

  Select Fire Evacuation Security Lockdown Medical Structal

  • Fire Evacuation
  • Security
  • Lockdown
  • Medical
  • Structal

• Relevant Emergency Service Contacted Pre and Post Exercise?

  Yes

  No

  N/A

• List of Emergency Services Contacted regarding Exercise

• Danger Zone Evacuation Time

  1 = under 60 seconds

  2 = under 1minute 30 seconds

  3 = under 2 minutes

  4 = under 2 minutes 30 seconds

  5 = over 2 minutes 30 seconds

• Evacuation: To Relative Safety

  1 = under 2 minutes

  2 = under 2 minutes 30 seconds

  3 = under 3 minutes

  4 = over 3 minutes

  5 = over 4 minutes

• Evacuation: To Total Safety

  1 = under 3 minutes

  2 = under 5 minutes

  3 = over 5 minutes

  4 = under 10 minutes

  5 = over 10 minutes

• Evacuation: To Dispersal Point

  1 = under 3 minutes

  2 = under 5 minutes

  3 = over 5 minutes

  4 = under 10 minutes

  5 = over 10 minutes

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?

  Safe location. Exercise can proceed

  Unsafe location and exercise should not continue

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

  Yes - informed to report this via their employers incident reporting system.

  None.

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?

  Yes - persons were made aware and/or and observer (with hi-visible jacket) was present

  Not used as part of this Evacuation Exercise.

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

  Yes - persons were made aware and/or and observer (with hi-visible jacket) was present

  Not used as part of this Evacuation Exercise.

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

  Yes - persons were made aware and/or and observer (with hi-visible jacket) was present

  Not used as part of this Evacuation Exercise.

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

Items

• Item 1

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

• Item 2

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

• Item 3

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

• Item 4

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

• Item 5

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

• Item 6

• Priority Rating:

  Very High Risk

  High Risk

  Medium Risk

  Low Risk

  Very Low Risk

• Location

• Nature and brief description:

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

• Person responsible for action:

• Target Date for completion:

  Date

• Status and Date - Complete or On-going

Part 5. Conclusion and Safety Rating

• Current Site/Building/Ward/Unit Fire Risk Rating

  Select High Life Risk Medium Life Risk Low Life Risk

  • High Life Risk
  • Medium Life Risk
  • Low Life Risk

• 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

  Sign

Exercise Report completion date:

• Auditors Signature

  Sign

• Pictures

  Media

Next Evacuation Exercise Review

• Recommended date for Exercise/Drill Re-Assessment

  Date