CHECKLIST FOR FLOOR WARDENS
Evacuations
Your Name: ______________________________________________________
Building:
______________________________________________________
Floor:
_______________________________________________________
Building Coordinator (BC) Name: _____________________________________
Note: Please use this checklist during drills and emergency evacuations as
guidelines to follow. Submit completed checklist to the Building Coordinator for
documentation.
Date:
______________________________________________________
Time:
______________________________________________________
Reason for Evacuation:
Drill
Emergency (nature of emergency): ______
________________________________________________________________
Y
N N/A
1. Don vest. Grab additional emergency equipment.
2. Facilitate evacuation by directing people to nearest safe exit.
Route people to primary assembly area unless unsafe to do
so. Use alternate assembly area if necessary.
3. Systematically sweep the area and check for persons in all
labs & rooms on your designated area or floor for effective
evacuation.
4. Check for persons in restrooms.
5. Close doors and place “Evacuated” door hanger on all
doorknobs after checking area.
6. Note any injuries on this floor.
7. For serious injuries, immediately dispatch a runner to notify
BC.
8. Assist persons with disabilities in accordance with individual
pre-plans. If person is remaining in building, notify BC of
location and assistance needed to expedite exit from building.
9. Report status of evacuation to BC. Note location of any
remaining individuals and reason for not evacuating.
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10. Report any hazardous conditions on this floor (fire, structural
damage, falling hazards, hazardous spill, etc.) to BC
immediately.
11. Assist BC to stop re-entry into the building if hazardous
conditions are suspected or until “all-clear” notice is made.
12. Assist BC with communications with evacuees on status of
event as much as possible.
13. Assist and support BC’s recovery activities.
14. Request release of duty from BC. If emergency is continuing,
hand-off vest and other equipment to replacement and
provide briefing.
15. Post-event - Document any other observations related to this
incident worth reporting.
16. Post-event - Participate in debriefing and development of
lessons learned.
17. Post-event - Replace vest, emergency equipment. Replenish
supplies as necessary.
Additional Actions Taken:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Comments, Additional Observations:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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