F202 Environmental Emergency Response Record

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Type of Environmental Emergency

• Type of Evacuation

  Trial

  False Alarm

  Actual Emergency

• Alarm sound

  Yes

  No

  N/A

• Wardens respond / verify emergency

  Yes

  No

  N/A

• Emergency services / SAPOL notified (not required for trial/test evacuations)

  Yes

  No

  N/A

• Wardens check area

  Yes

  No

  N/A

• Staff / Customers at assembly point

  Yes

  No

  N/A

• All personnel accounted for

  Yes

  No

  N/A

• Emergency services / SAPOL arrived on-site (not required for trial/test evacuations)

  Yes

  No

  N/A

• Senior Management Updated (not required for trial/test evacuations)

  Yes

  No

  N/A

• 'All clear' given by emergency services (not required for trial/test evacuations)

  Yes

  No

  N/A

• Evacuation completed

  Yes

  No

  N/A

Response to Scenario

• Issue assessed

  Yes

  No

  N/A

• Response instigated

  Yes

  No

  N/A

• Responsibility allocated

  Yes

  No

  N/A

• Equipment available to address issue

  Yes

  No

  N/A

• People able to use required equipment

  Yes

  No

  N/A

• Issue addressed

  Yes

  No

  N/A

• Site emergency plan used

  Yes

  No

  N/A

• Exercise terminated

  Yes

  No

  N/A

• Observations/Comments

Suggested Action

• How would you rate the overall drill/response

  Good

  Fair

  Poor

  N/A

• Effectiveness of procedures

  Good

  Fair

  Poor

  N/A

• Speed of evacuation

  Good

  Fair

  Poor

  N/A

• Communications

  Good

  Fair

  Poor

  N/A