Fire/Tornado Drill Documentation

• Document No.

• Prepared by

• Date and time of alarm

  Date

• Type of alarm

  Fire

  Tornado

  Fire alarm test only

• Who initiated the alarm?

  Select EHS supervisor Production supervisor Maintenance technician Plant manager Warehouse supervisor Laboratory supervisor Other Automatically initiated

  • EHS supervisor
  • Production supervisor
  • Maintenance technician
  • Plant manager
  • Warehouse supervisor
  • Laboratory supervisor
  • Other
  • Automatically initiated

• Provide employee name and reason for initiation

• Select reason for alarm

  Sprinkler system

  Smoke alarm system

  Other

• Explain

• Enter location used to initiate alarm

  Select Lobby Main offices downstairs Main offices upstairs Downstairs lab Upstairs lab Warehouse Production Maintenance shop Other Automatically initiated

  • Lobby
  • Main offices downstairs
  • Main offices upstairs
  • Downstairs lab
  • Upstairs lab
  • Warehouse
  • Production
  • Maintenance shop
  • Other
  • Automatically initiated

• Explain

• Enter specific location

• Select reason

  Sprinkler system

  Smoke alarm system

  Other

• Explain

• Did the alarm sound properly in all areas?

  Yes

  No

  N/A

• Please note areas where alarm did not sound

• Projected date of resolution

  Date

• Responsible party

  Sign

• Enter location used to initiate alarm

  Upstairs lab

  Downstairs lab

  Production

  Warehouse

• Who initiated the alarm?

  Select EHS supervisor Production supervisor Maintenance technician Plant manager Warehouse supervisor Laboratory supervisor Other Automatically initiated

  • EHS supervisor
  • Production supervisor
  • Maintenance technician
  • Plant manager
  • Warehouse supervisor
  • Laboratory supervisor
  • Other
  • Automatically initiated

• Provide employee name and reason for initiation

Response times

• Production personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Laboratory personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Repack and warehouse personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Office personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Fire department response time

• Explain delay

Visitors, drivers, and other personnel

• Are all visitors accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Are all drivers accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Are employee lists available and current?

  Yes

  No

  N/A

• Explain why list is not current

• Target date for lists to be updated

  Date

• Responsible party for updating lists

  Sign

• Who initiated the alarm?

  Select EHS supervisor Production supervisor Maintenance technician Plant manager Warehouse supervisor Laboratory supervisor Other Automatically initiated

  • EHS supervisor
  • Production supervisor
  • Maintenance technician
  • Plant manager
  • Warehouse supervisor
  • Laboratory supervisor
  • Other
  • Automatically initiated

• Provide employee name and reason for initiation

• Select reason for alarm

  Sprinkler system

  Smoke alarm system

  Other

• Explain

• Enter location used to initiate alarm

  Select Lobby Main offices downstairs Main offices upstairs Downstairs lab Upstairs lab Warehouse Production Maintenance shop Other Automatically initiated

  • Lobby
  • Main offices downstairs
  • Main offices upstairs
  • Downstairs lab
  • Upstairs lab
  • Warehouse
  • Production
  • Maintenance shop
  • Other
  • Automatically initiated

• Explain

• Enter specific location

• Select reason

  Sprinkler system

  Smoke alarm system

  Other

• Explain

• Was the fire department notified prior to the alarm being sounded?

  Yes

  No

  N/A

• Date and time of notification

  Date

• Person who contacted

  Sign

• Please explain

• Was the alarm monitoring company notified prior to the alarm being sounded?

  Yes

  No

  N/A

• Date and time of notification

  Date

• Person who contacted

  Sign

• Please explain

Response times

• Production personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Laboratory personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Repack and warehouse personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Office personnel response time

• Explain delay

• Are all personnel accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Fire department response time

• Explain delay

Visitors, drivers, and other personnel

• Are all visitors accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Are all drivers accounted for?

  Yes

  No

  N/A

• Name of individual(s) missing

• Are employee lists available and current?

  Yes

  No

  N/A

• Explain why list is not current

• Target date for lists to be updated

  Date

• Responsible party for updating lists

  Sign

• Did anyone leave the assembly area?

  Yes

  No

  N/A

• Please explain

• Valves checked open?

  Yes

  No

  N/A

• Name of person who checked

  Sign

• Explain why not checked