Emergency Exit Drill
Date: / Type of emergency drill: / Start of drill (time):
Location: / Person in charge at location:
Fire Alarm Sounded (time): / Evacuation (time):
Emergency back-up key response time (Condition V Use Only): / Head Count is cleared (time):
The following checklist will be completed by checking “Yes,” “No” or “N/A” in the appropriate space.
Yes / No / N/ACall made to Fire Department (911).
Call made to operations.
Location given.
Location of fire given.
Persons closest to fire evacuated first.
Doors closed after people have been evacuated.
Assembly made at safe distance from building.
Count made and all persons accounted for.
Count reported to operations.
Did the alarms function properly?
Comments:
Reviewed by Fire Safety Officer-Signature / Date
Person Conducting the Drill-Signature/Title / Date
Shift Supervisor-Signature / Date
Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.
Distribution: Fire Safety Inspector
Copy- Facility
CS-0234, Rev 03/11 Page 1 of 1