TORNADO OR SEVERE STORM DRILL AND EVALUATION
Tornado Drills do not need to be performed in the months of: Nov, Dec, Jan and Feb. All other months submit monthly.
HOME
MANAGER
DATE
/
Month
/
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
# CLIENTS PRESENT
# STAFF PRESENT
How were people alerted that they were to go to the safe area
Location of "Safe Area"
STEP BY STEP ACTIONS TAKEN BY STAFF
Check All Items that Apply during your evacuation
Keys and Phone were taken
Emergency Bag was Taken
Verbal Praise was given
Reinforcement was given
Evacuation route was clear
The ALL CLEAR was given before return
Stayed at evacuation site at least 5 minutes
Length of time needed to get to safe area:
Name of destination
Person Completing Form
Date
/
Month
/
Day
Year
Date
EVALUATION
Home Manager
Comments
QI Monitor
Comments
Corrective Actions Needed
no
yes (if yes, review comments with staff)
Safety Committee
Revised
Preview PDF
Submit
Should be Empty: