Critical Response and School Emergency Management Guide – SY 2015-16
School Drill and Evacuation Log
School Name and Number : _________________________________________________________________
Weather Radio Used by the Main Office Staff:
Yes:
No:
Record all drills and evacuations for your school. Contact the School Police Office prior to activating the fire alarm.
 Completed copies of this form must be provided to your Network Liaison in November and April of year school
year.
I.
Fire Drills (note changes to prior year requirements):
a. Schools that are fully protected by an Automatic Sprinkler System must conduct 5 fire drills
during the school year. Two out of the 5 must be conducted in the first 4 months of the school
year.
b. Schools that are not fully protected by an Automatic Sprinkler System must conduct 8 fire drills
during the school year. Three out of the 8 must be conducted in the first 4 months of the school
year.
Date
Conducted
Weather
Conditions
Number of
Occupants
Time
Signature:
Conducted: Principal or Asst Prin
1st Sept:
2nd Oct.:
3rd Nov.:
4th Dec.:
5th
6th
7th:
8th:
II.
Bus Evacuation Drills –Two Per School Year (September and February – flip over for
additional columns)
1) Date:
Time:
Bus Contractor and Bus #:
Signature: Bus Driver
2) Date:
Time:
Bus Contractor and Bus #:
Signature: Bus Driver
III.
Additional Drills – One Per School Year. For Guidance, See Section 3
1) Evacuation
Date Held:
Time Occurred:
Signature, Principal or AP:
2) Shelter-In-Place
Date Held:
Time Occurred:
Signature, Principal or AP:
3) Reverse Evacuation/Alert Status
Date Held:
Time Occurred:
Signature, Principal or AP:
4) Lockdown
Date Held:
Time Occurred:
Signature, Principal or AP:
5) Severe Weather/ Safe Area
Date Held:
Time Occurred:
Signature, Principal or AP:
6) Drop, Cover, and Hold On
Date Held:
Time Occurred:
Signature, Principal or AP:
Appendix-Page 1
Critical Response and School Emergency Management Guide – SY 2015-16
II.
additional columns for Bus Evacuations, if required
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Date:
Time:
Bus Contractor and Bus Number:
Bus Driver, Signature:
Appendix –Page 2