Title Page
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Record completed by
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Evacuation conduct on
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Evacuation location
1. Evacuation Purpose
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Evacuation cause:
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Explain the details of the evacuation and the cause
2. Evacuation Details
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Was the entire office/facility adequately evacuated?
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Were all personnel involved in the evacuation?
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Were all personnel co-operative in leaving their work areas?
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Was the alarm audible in all areas?
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Was the emergency evacuation adequate for current arrangements? (i.e. response time too long)
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Was access adequate to all areas of site and/or exit points?
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Were all personnel accounted for and numbers given to the office manager?
3. Personnel Sign Off
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
4. Additional Comments
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If any element of the drill is determined to be inadequate, the office manager is required to modify the Emergency Management Procedure and undertake a further evacuation drill within a 90-day period. The inadequacies are:
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[ENTER COMMENTS/CONCERNS HERE]
