Emergency Drill Report Checklist
Name of person completing form
Location
Were emergency
services notified?
Yes / No
Time of drill
Date
Was alarm activated
If Fire brigade attended, what was
response time?
Number of persons in building at time of evacuation.
All persons evacuated successfully?
Yes / No
If not why?
Persons with disabilities evacuated successfully?
Yes / No
If not why?
Did all persons evacuate to the assembly area?
Yes / No
If not why?
All rooms and surrounds checked appropriately?
Yes / No
Did anyone re-enter building before all clear was given?
Yes / No
Were wardens clear on roles?
Yes / No
If no, why?
Problems / issues to be raised.
Trim to Container -46/544/0004 Human Resources - Occupational Health & Safety ( OH&S ) Evacuation Plan (Department sub folder)
Trim Reference
M10/100470
Issue Number:
1
Endorsed by
The Executive
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