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: |
| | | |
|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: | |
| | | |
|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? | |
| | | |
|Yes |Yes | |
|No |No | |
| | | |
|Incident Command System Used? |Incident Commander: |Operations Chief: |
| | | |
|Yes | | |
|No | | |
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|Emergency Drill Reporting Form (Cont’d) |
|Problems Encountered: (Check all that apply) | |
| | |
|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: ____________________________ |
| |__________________________________ |
|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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