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Emergency Drill Reporting Form

This document is an emergency drill reporting form that collects information about a recent emergency drill. It documents the date, time, type of drill (e.g. fire evacuation, lockdown), participants, notification method, weather, problems encountered, and plans for improvement. The form is used to evaluate the drill and identify areas for enhanced training or emergency response procedures.

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IbraahimShareef
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5K views3 pages

Emergency Drill Reporting Form

This document is an emergency drill reporting form that collects information about a recent emergency drill. It documents the date, time, type of drill (e.g. fire evacuation, lockdown), participants, notification method, weather, problems encountered, and plans for improvement. The form is used to evaluate the drill and identify areas for enhanced training or emergency response procedures.

Uploaded by

IbraahimShareef
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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[Y

Emergency Drill Reporting Form


Person
Completing
Form and Title:

Date:

Attach to this form a list of all staff who participated in the drill, and any visitors
participating.

Time Alarm Sounded:

Time Drill Concluded:

Time to Evacuate: (fire


evacuation drills only)

Type of Drill:

Fire / Evacuation
Lockdown
Modified Lockdown
Shelter-in-Place
Earthquake
Tsunami
Medical Emergency
Lahar
Weather Emergency
Other:
__________________

Participants: (check all that


apply)

Senior Management
Safety Personnel
Employees/Staf
Security Officers
Law Enforcement
Fire Department
Emergency Medical
Services
County Emergency
Mgmt.
Other
___________________

Management previously
trained on emergency
procedures this year?
Yes
No

Incident Command System


Used?

Notification / Alert
Method:
Bell or Buzzer
Enhanced Alert
System
Intercom
Phone
Voice Notification
Siren
Other: ______________

Weather Conditions:

Clear
Cloudy
Raining
Rain and wind
Windy
Snow / Sleet
Hail

Situation at Start of Drill:

Before Business Hours


During Business Hours
Peak Business Hours
Lunch Time
After Business Hours
Other: _______________
_____________________

Employees previously
trained on emergency
procedures this year?
Yes
No

Incident Commander:

Operations Chief:

Yes
No

Emergency Drill Reporting Form (Contd)


Problems Encountered: (Check all that apply)
Congestion in hallways

Alarm not heard

Employees unsure of what to do /

proper

Staf unsure of responsibilities /


response

Weather-related problems

Unable to lock doors

Windows not covered

Windows left open

Doors left open

Lights left on

Personnel not accounted for /

attendance

Difficulties with evacuation of disabled


personnel, customers or visitors
Personnel unaccounted for (note #
below)
Extenuating Circumstances / Identified Factors /

Radio communication problems


Network / computer problems
Noise impedes communications
Personnel not out of sight (lockdown
drill)
Long time to evacuate building
Personnel not serious about drill
Improper or unavailable supplies (SiP)
Confusion
Doors or Exits blocked
Transportation
Interagency miscommunications
Incident command problems
Other: ____________________________
__________________________________

Special Conditions Simulated:

Mitigation / Plans for Improvement: (check all that apply and explain below)

Additional management training


Additional staf training
Address need for additional equipment
Improved emergency supplies

Cooperative planning with responders


Revised emergency procedures
Other:

Explain corrective efforts here:

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