"Fire Drill Evaluation Report Template"

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Fire Drill Evaluation Report
Circle Yes or No only for those evaluation areas you observed
Point of
Drill Date
Origin
Department
Shift
Evaluator
Time Start
Name
Initiation
Time
Method
Completed
Areas of Evaluation
All inside doors were closed after alarm
Yes No
NA
Gas Valves & other flammable service valves shut
Yes No
NA
Employees familiar with Alarm box locations and use
Yes No
NA
Employees know emergency phone numbers
Yes No
NA
Paging system was operated correctly
Yes No
NA
Announcing system was operated correctly
Yes No
NA
Fire alarm audible and visual indicators functioned
Yes No
NA
properly
Evacuation was orderly and controlled by supervisors
Yes No
NA
Equipment was shutdown during evacuation
Yes No
NA
Employees used correct evacuation routes
Yes No
NA
Employees gathered at correct relocation areas (Elapsed
Yes No
NA
Time _______)
No obstacles in evacuation paths
Yes No
NA
Emergency exit routes clearly marked
Yes No
NA
Emergency Exit doors not blocked - worked properly
Yes No
NA
Supervisors followed emergency response plan
Yes No
NA
Management followed emergency response plan
Yes No
NA
Critical document control and removal plan executed
Yes No
NA
Fire Department called (by pre-arrangement) Response
Yes No
NA
time ______
Police response time ____________
Yes No
NA
Utilities shut off in affected areas (Elapsed time
Yes No
NA
__________
Fire Brigade on-scene time (Elapsed time _________)
Yes No
NA
Fire properly brought under control (Elapsed time
Yes No
NA
_______)
Fire was extinguished (Elapsed time _____________)
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Comments & Notes
Fire Drill Evaluation Report
Circle Yes or No only for those evaluation areas you observed
Point of
Drill Date
Origin
Department
Shift
Evaluator
Time Start
Name
Initiation
Time
Method
Completed
Areas of Evaluation
All inside doors were closed after alarm
Yes No
NA
Gas Valves & other flammable service valves shut
Yes No
NA
Employees familiar with Alarm box locations and use
Yes No
NA
Employees know emergency phone numbers
Yes No
NA
Paging system was operated correctly
Yes No
NA
Announcing system was operated correctly
Yes No
NA
Fire alarm audible and visual indicators functioned
Yes No
NA
properly
Evacuation was orderly and controlled by supervisors
Yes No
NA
Equipment was shutdown during evacuation
Yes No
NA
Employees used correct evacuation routes
Yes No
NA
Employees gathered at correct relocation areas (Elapsed
Yes No
NA
Time _______)
No obstacles in evacuation paths
Yes No
NA
Emergency exit routes clearly marked
Yes No
NA
Emergency Exit doors not blocked - worked properly
Yes No
NA
Supervisors followed emergency response plan
Yes No
NA
Management followed emergency response plan
Yes No
NA
Critical document control and removal plan executed
Yes No
NA
Fire Department called (by pre-arrangement) Response
Yes No
NA
time ______
Police response time ____________
Yes No
NA
Utilities shut off in affected areas (Elapsed time
Yes No
NA
__________
Fire Brigade on-scene time (Elapsed time _________)
Yes No
NA
Fire properly brought under control (Elapsed time
Yes No
NA
_______)
Fire was extinguished (Elapsed time _____________)
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Yes No
NA
Comments & Notes