Emergency Drill Reporting Form - TRANE MidAmerica



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|Emergency Drill Reporting Form |

|Person Completing | |Date: | |

|Form and Title: | | | |

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: |Notification / Alert Method: |Weather Conditions: |

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|Fire / Evacuation |Bell or Buzzer |Clear |

|Lockdown |Enhanced Alert System |Cloudy |

|Modified Lockdown |Intercom |Raining |

|Shelter-in-Place |Phone |Rain and wind |

|Earthquake |Voice Notification |Windy |

|Tsunami |Siren |Snow / Sleet |

|Medical Emergency |Other: ______________ |Hail |

|Lahar | | |

|Weather Emergency | | |

|Other: __________________ | | |

|Participants: (check all that apply) |Situation at Start of Drill: | |

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|Senior Management |Before Business Hours | |

|Safety Personnel |During Business Hours | |

|Employees/Staff |Peak Business Hours | |

|Security Officers |Lunch Time | |

|Law Enforcement |After Business Hours | |

|Fire Department |Other: _______________ | |

|Emergency Medical Services |_____________________ | |

|County Emergency Mgmt. | | |

|Other ___________________ | | |

|Management previously trained on emergency procedures |Employees previously trained on emergency | |

|this year? |procedures this year? | |

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|Yes |Yes | |

|No |No | |

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|Incident Command System Used? |Incident Commander: |Operations Chief: |

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|Yes | | |

|No | | |

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|Emergency Drill Reporting Form (Cont’d) |

|Problems Encountered: (Check all that apply) | |

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|Congestion in hallways |Radio communication problems |

|Alarm not heard |Network / computer problems |

|Employees unsure of what to do / proper |Noise impedes communications |

|Staff unsure of responsibilities / response |Personnel not out of sight (lockdown drill) |

|Weather-related problems |Long time to evacuate building |

|Unable to lock doors |Personnel not serious about drill |

|Windows not covered |Improper or unavailable supplies (SiP) |

|Windows left open |Confusion |

|Doors left open |Doors or Exits blocked |

|Lights left on |Transportation |

|Personnel not accounted for / attendance |Interagency miscommunications |

|Difficulties with evacuation of disabled personnel, customers or visitors |Incident command problems |

|Personnel unaccounted for (note # below) |Other: ____________________________ |

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|Extenuating Circumstances / Identified Factors / Special Conditions Simulated: |

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

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|Additional management training |Cooperative planning with responders |

|Additional staff training |Revised emergency procedures |

|Address need for additional equipment |Other: |

|Improved emergency supplies | |

|Explain corrective efforts here: |

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