Emergency Drill Reporting Form | Safety & Preparedness

Emergency Drill Reporting Form Attach to this form a list of all staff who participated in the drill, and any visitors participating. Project Name& No.: Drill Location: Mock Drill Ref No: Name of Emergency Coordinator: Drill Concluded: Drill Date: Name of Fire Warden: Time Alarm Sounded: Time to Evacuate: Type of Drill:             Fire / Evacuation Suspension trauma Confined Space rescue Electric Shock Excavation collapse rescue Environmental spill □ Land □ Marine Medical Emergency Rescue from Water Vessel Emergencies Diving Emergencies Weather Emergency Other: __________________ Notification / Alert Method:        Bell or Buzzer Enhanced Alert System Intercom Phone Voice Notification Siren Other: ______________ Participants: (check all that apply)        Senior / Line Management ERP team Safety Personnel Employees / Staff Client / 3RD Party Subcontractor Other_______________ Weather Conditions:       Clear Cloudy Raining Rain and wind Windy Others:_______________ Situation at Start of Drill:       Before Business Hours During Business Hours Peak Business Hours Lunch Time After Business Hours Other________________ Describe the site area condition/ situation on the start of the drill Brief Description / Scenario on Emergency Situation (If required) Mock Drill Pictures Performance of Responses & Strategy Procedures Followed: □ Satisfactory □ Unsatisfactory □ Needs Improvement Mock Drill: □ Organized □ Unorganized Positive Observation (If any) Page 1 of 2 A A Dutco Group Company WP-HSE-011-FRM-01 Issue 2.0 / 17.01.2024 Emergency Drill Reporting Form Problems Encountered: (Check all that apply)              Congestion in hallways Alarm not heard Employees unsure of what to do / proper Emergency equipment not available Doors / Windows left open No awareness towards ERP contact list Incident communication protocol not adhered Personnel not accounted for / attendance Difficulties with evacuation of disabled personnel, customers, or visitors  Area not cordoned / secured  ERT Fails to perform duties and responsibilities  No / Lack of Directional Signages Corrective Action for Problems Encountered        Radio communication problems Un organized Personnel movement Long time to evacuate building Exceeds the optimum evacuation time/ rescue Personnel not serious about drill Insufficient or unavailable supplies Emergency Doors or Exits blocked Delay of Emergency Response Vehicle Interagency miscommunications Assembly point too close Other: ____________________________ __________________________________ Responsible Person Target Date Mitigation / Plans for Improvement: (check all that apply and explain below)  Duty of Care  Additional training required  Increase awareness familiarity to drill / more drills  Additional rescue equipment & Emergency supplies Explanation of Mitigation / Plans for Improvement  Improved Cooperation required from personnel  Review / Revise Emergency Procedures  Other: Responsible Person Target Date Lessons Learnt / Area for Improvement/Other Comments Reviewed By : …………………………………………………….. Date : ………………………………………………….…. Signature : ………………………………………………….…. Remarks / Comments Approved By : …………………………………………………… Date : ………………………………………………….… Signature : ………………………………………………….…. Remarks / Comments Page 2 of 2 A A Dutco Group Company WP-HSE-011-FRM-01 Issue 2.0 / 17.01.2024

Emergency Drill Reporting Form | Safety & Preparedness

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Emergency Drill Reporting Form | Safety & Preparedness

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