Fire Evacuation Evaluation Form

• Service conducted

  Select

• Conducted on

  Date

• Prepared by

• Where the Emergency Occurred

• Staff Member who called the Emergency

• Staff Member Evaluating the Emergency Response

• Persons who Attended

• Number of Children Involved

Rooms Involved in Evacuation

• Nursery

  Yes

  No

  N/A

• Number of Children on the Roll for the day

• Number of Children accounted for at the time of the drill

• Fire evacuation bag checked?

  Yes

  No

  N/A

• Toddler

  Yes

  No

  N/A

• Number of Children on the roll for the day

• Number of Children accounted or at the time of the drill

• Fire evacuation bag checked?

  Yes

  No

  N/A

• Jnr Kindy

  Yes

  No

  N/A

• Number of Children listed on the roll for the day

• Number of children accounted for at time of the drill

• Fire evacuation bag checked?

  Yes

  No

  N/A

• Senior Kindy

  Yes

  No

  N/A

• Number of children listed on the roll for the day

• Number of Children accounted for at the time of the drill

• Fire evacuation bag checked?

  Yes

  No

  N/A

• Kindergarten

  Yes

  No

  N/A

• Number of children listed on the roll for the day?

• Number of children accounted for at the time of the drill

• Fire evacuation bag checked?

  Yes

  No

  N/A

Evaluation

• Evacuation Procedure

• Staff Performance

• Childrens Performance

• Other Feedback

Points to be discussed at next staff meeting

• Staff meeting agenda points