Evacuation Practice Checklist - TEMPLATE

• Conducted on -

  Date

• Start time

  Date

• End time

  Date

• Prepared by - Lee Bird

• Emergency exit lighting properly illuminated

  Yes

  No

  N/A

• Egress routes properly illuminated

  Yes

  No

  N/A

• Egress routes free from obstruction

  Yes

  No

  N/A

• Designated Assembly Area in an appropriate and safe place

  Yes

  No

  N/A

Evacuation Diagrams

• Evacuation diagrams in required locations

  Yes

  No

  N/A

• Evacuation diagrams securely fastened and orientated for the building

  Yes

  No

  N/A

• Evacuation diagrams contain the required information

  Yes

  No

  N/A

Communications

• Evacuation practice pre-announced

  Yes

  No

  N/A

• Method of evacuation activation

Fire Alarm Systems

• Fire alarm heard clearly in all areas

  Yes

  No

  N/A

• Public address heard in all areas

  Yes

  No

  N/A

• Elevators used in evacuation

  Yes

  No

  N/A

Fire Containment

• Rooms checked prior to closing doors

  Yes

  No

  N/A

• Doors closed and left unlocked

  Yes

  No

  N/A

• Any other recommendations

  Yes

  No

  N/A

Evacuation

• All occupants participated and evacuated

  Yes

  No

  N/A

• Restrooms were checked for occupants

  Yes

  No

  N/A

• Evacuation was orderly

  Yes

  No

  N/A

Plan

• Evacuation performed according to plan

  Yes

  No

  N/A

• Emergency incident response team carried out assigned duties

  Yes

  No

  N/A

• Occupants met at a designated assembly area

  Yes

  No

  N/A

• Occupants register log taken to assembly area

  Yes

  No

  N/A

• Comments

Number of occupants evacuated

• Staff

• Children/babies

• Visitors

Other recommendations

• undefined