Fire Drill Assessment Form

• Document No.

• CONDUCTED FOR:

• CONDUCTED BY:

• MONITORED BY:

• CONDUCTED ON:

  Date
• LOCATION:
  Address

EVALUATION:

• COMMENTS:

• Evacuation Start Time:

  Date

• Evacuation End Time:

  Date

• Total time for evacuation process:

• Was the building completely evacuated [except exempt personal & areas]?

  Yes

  No

  NA

• Were any areas exempt from this drill?

  Yes

  No

  N/A

• List exempt areas:

• List reasons for exemption

• List exempt personal:

• Were exempt employees instructed on what to do in case of an actual emergency and how to properly evacuate their area!

  Yes

  No

  NA

• Was the evacuation alarm heard in every area of the building?

  Yes

  No

  NA

• Did all occupants meet at their designated meeting point?

  Yes

  No

  NA

• Areas of refuge identified & posted?

  Yes

  No

  NA

• Have procedures for the handicapped been addressed?[PEEPs, areas of refuge etc.] please list below

  Yes

  No

  NA

• Have procedures for identifying visitors locating and assisting in their evacuation been addressed?

  Yes

  No

  NA

• List handicapped procedures:

• Did equipment (doors, alarms, pull stations, exit signs, etc.) function properly?

  Yes

  No

  NA

• Any problems or issues

  Yes

  No

  N/A

• List problems:

• List other issues:

• Time it took for the fire alarm to come into dispatch?

• Number of people evacuated?

• Building Representative:

• Drill Evaluator:

• Responsible person provided instructions prior to starting drill?

  Yes

  No

  NA

• Responsible person provided debrief at end of drill?

  Yes

  No

  NA

• Final Comments:

• GENERAL NOTES

• Concerns?

• Evacuation routes posted?

  Yes

  No

  NA

• Evacuation route signs in good condition?

  Yes

  No

  NA

• Exits clearly marked & free of obstructions?

  Good

  Fair

  Poor

  N/A

• Emergency lights & exit signs properly illuminated?

  Good

  Fair

  Poor

  N/A

• Exit doors operating properly?

  Good

  Fair

  Poor

  N/A

• Egress routes properly lighted?

  Good

  Fair

  Poor

  N/A

COMMUNICATION:

• Method of drill activation

• Fire department present & participating?

  Yes

  No

  NA

• Security notified & participating

  Yes

  No

  NA

• Alarm company notified & participating?

  Yes

  No

  NA

FIRE CONTAINMENT

• Doors & windows closed?

  Yes

  No

  NA

• Rooms checked prior to closing doors?

  Yes

  No

  NA

• Rest rooms checked for occupants?

  Safe

  At Risk

  N/A

• Doors left unlocked?

  Yes

  No

  NA

UTILITIES

• Electrical appliances were turned off?

  Yes

  No

  NA

• Lights were turned off?

  Yes

  No

  NA

• Electrical equipment turned off

  Yes

  No

  NA

• HVAC units shut down with alarm?

  Yes

  No

  NA

• Electromagnetic locked doors operated correctly?

  Yes

  No

  NA

• Door hold open devices operated correctly?

  Yes

  No

  NA

PLAN

• Evacuation performed according to plan?

  Yes

  No

  NA

• Elevators recalled to correct floor?

  Yes

  No

  NA

• Meeting place at a safe distance from building?

  Yes

  No

  NA

• Drill / Response team acted according to plan?

  Yes

  No

  NA

• Drill leaders / Response team easy to identify [ vests etc.] ?

  Yes

  No

  NA

• Notes on drill leaders / response team:

• Visitors escorted and accounted for?

  Yes

  No

  NA

• Roll call proper and correct?

  Safe

  At Risk

  N/A

• Special needs persons accommodated? [PEEP] [personal emergency evacuation plan]

  Safe

  At Risk

  N/A

• Appropriate procedures for All Clear & returning to normal operations?

  Yes

  No

  NA

• Procedures in place for liaising with Fire Service Officer In Charge?

  Yes

  No

  NA

• Overall response of occupants?

  Good

  Fair

  Poor

  N/A

• NUMBER OF STAFF EVACUATED?

• NUMBER OF VISITORS EVACUATED?