SVPHM - Mock Code Observer Report

• Mock Code Report

• Mock Code

  Select Red Orange Yellow Purple Black Brown

  • Red
  • Orange
  • Yellow
  • Purple
  • Black
  • Brown

• Site

• Fitzroy

• East Melbourne

• Kew

• Other

• Location

• Location of code

• Document No.

• Conducted on

  Date

• Observer name

• Observer location

• Who attended?

  Select Engineering Environmental Services Security Business Office Emergency coordinator Emergency warden other

  • Engineering
  • Environmental Services
  • Security
  • Business Office
  • Emergency coordinator
  • Emergency warden
  • other

• What was the specific emergency? (Description)

• What was the sequence of events?

• Time call made to 7777

  Date

• Time PA announcement made?

  Date

• Time staff reported to assembly area?

  Date

• Did all staff report assembly area and await instructions?

  Yes

  No

  N/A

• Time ALL CLEAR announced over PA?

  Date

• Did the warden wear the hat and vest?

  Yes

  No

  N/A

• Was use of the lifts prevented?

  Yes

  No

  N/A

• Did the warden instruct staff to check their areas and report back?

  Yes

  No

  N/A

• Was a count of staff and visitors conducted?

  Yes

  No

  N/A

• Was the area of the code isolated?

  Yes

  No

  N/A

• Based on the above response, did the response differ from standard procedures?

  Yes

  No

• Feedback provided to department?

  Yes

  No

  N/A

Required actions

• Further training

• Date & time training scheduled for

  Date

• Equipment repair / replacement / provision

• What equipment requires repair / replacement / provision?

• Procedure update / revision

• What needs to be changed?

• Follow up with non compliant staff, AMP's or contractors?

• Who is responsible for follow up?