To save as PDF: use your browser's Print → Save as PDF. This form prints as A4.
Documentation of evacuation drill performance, timing, and corrective actions
Mark P (Pass), F (Fail), or N/A for each item. Record observations and improvement actions in the Notes column.
| # | Assessment Item | P | F | N/A | Notes |
|---|---|---|---|---|---|
| Alarm & Notification | |||||
| 1 | Alarm activated and audible throughout entire building | ☐ | ☐ | ☐ | |
| 2 | Visual alarm indicators (strobes) functioning in all areas | ☐ | ☐ | ☐ | |
| 3 | PA announcement clear and instructions understandable | ☐ | ☐ | ☐ | |
| 4 | Monitoring company notified before drill commenced | ☐ | ☐ | ☐ | |
| Evacuation Timing | |||||
| 5 | Occupants began evacuating within 60 seconds of alarm | ☐ | ☐ | ☐ | |
| 6 | Total evacuation completed within target time | ☐ | ☐ | ☐ | |
| 7 | Stairwells not congested, orderly flow maintained | ☐ | ☐ | ☐ | |
| 8 | Mobility-impaired persons assisted per refuge procedures | ☐ | ☐ | ☐ | |
| 9 | Lifts not used for evacuation (unless designated fire lift) | ☐ | ☐ | ☐ | |
| Sweep Procedures | |||||
| 10 | Floor wardens conducted sweep of all rooms and toilets | ☐ | ☐ | ☐ | |
| 11 | All fire doors closed after sweep | ☐ | ☐ | ☐ | |
| 12 | Wardens reported floor clear to chief warden | ☐ | ☐ | ☐ | |
| 13 | Exits and egress paths clear of obstructions | ☐ | ☐ | ☐ | |
| Assembly Verification | |||||
| 14 | All occupants reported to correct assembly area | ☐ | ☐ | ☐ | |
| 15 | Roll call or headcount completed and reconciled | ☐ | ☐ | ☐ | |
| 16 | Visitors and contractors accounted for | ☐ | ☐ | ☐ | |
| 17 | Assembly area away from building, driveways, and hazards | ☐ | ☐ | ☐ | |
| 18 | Chief warden communicated all-clear appropriately | ☐ | ☐ | ☐ | |
| Debrief & Actions | |||||
| 19 | Post-drill debrief conducted with wardens and management | ☐ | ☐ | ☐ | |
| 20 | Improvement actions documented with responsible persons | ☐ | ☐ | ☐ | |
| 21 | Emergency plan reviewed for any required updates | ☐ | ☐ | ☐ | |
| 22 | Next drill date scheduled (within 12 months) | ☐ | ☐ | ☐ | |
Declaration
I confirm this evacuation drill was conducted in accordance with the site Emergency Plan and applicable WHS legislation. All identified improvements have been documented and assigned for rectification prior to the next scheduled drill.
Free template from MapTrack · Latest version: maptrack.com/templates/emergency-evacuation-drill-record · Want it digital? Start free with MapTrack