Emergency Response Drill Checklist
Date of Drill:
*
-
Month
-
Day
Year
Date
Drill Lead By:
*
Email
example@example.com
Type of Drill:
*
Please Select
Evacuation
Medical Emergency
Rescue from Height
Explosion
Flood
Threat of Violence
Trench Collapse
Utility
Work Site
*
500 Railway Ave
Alexander Hotel
Black Swift Lodge
Grey Wolf Lodge
McCaffery
Mountain Lynx Lodge
Multiple Sites
RV
Spring Creek Gate Road Extension
The Franklin Hotel
TMV & MLV
Type Site Name
Muster Point:
*
Evaluation
*
Rows
Yes/ No
Improvements Needed
Was the emergency response system tested?
Yes
No
Did everyone follow the evacuation routes?
Yes
No
Was the evacuation carried out in an orderly fashion?
Yes
No
Did everyone go to the designated meeting area(s) (muster point)?
Yes
No
Was there an accurate head count?
Yes
No
Were all communications equipment tested?
Yes
No
Did all communications equipment function properly?
Yes
No
Were any special hazards discovered?
Yes
No
Evacuation start time:
*
Hour Minutes
AM
PM
AM/PM Option
Evacuation end time:
*
Hour Minutes
AM
PM
AM/PM Option
Total evacuation time:
*
Total number evacuated:
*
Summary of completed drill:
(i.e. what worked well, what needs improvement)
Follow Up Action Required:
Corrective Action
Assigned to:
Target Date:
-
Month
-
Day
Year
Date
Date Completed:
-
Month
-
Day
Year
Date
Corrective Action
Assigned to:
Target Date:
-
Month
-
Day
Year
Date
Date Completed:
-
Month
-
Day
Year
Date
Improvements/Corrections Made:
Attendance Sheet
*
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