REFERENCE NO FK-EHS-ED-01

RE REVISION 1
REVISION DATE 28-11-18

EVACUATION DRILL REPORT

Facility: Location:
Date of Drill: Time:
Planned /
Evacuation Type:
Unplanned:

Method Used for Initiating Manual blowing of whistle / activation of alarm

Evacuation:
Others Specify 
Time of Initial Time when Last Person
Alarm / Whistle: Exited the Warehouse:
Yes
Could the Alarm / Whistle be Heard
in all Locations? No Specify
reason
Yes
Were all Occupants / Workers
Accounted for? No specify who,
why 
Head Count at Assembly Point:

Employees –

Contractors –

Visitors –

Total –

What needs to be improved? (problems encountered during the entire operation)

What went well (Positive findings):

Did any special training needs arise?

Names of the Emergency response team on duty and participating as leads:

1
 REFERENCE NO FK-EHS-ED-01
RE REVISION 1
REVISION DATE 28-11-18

Name Team ERT Role Signature

Response Time (in Minutes):

List the Corrective Actions to be adopted as a result of this Evacuation Drill:

S.No. Action Points Counter Measures Responsibility Target
Date

Any trainings conducted:

If Yes, Name of the training:

Evacuation Drill Photos:

Signature / Date:

FST: Site Lead:

After each evacuation drill, send copies of report to: Management Representative