EXPONENT CONTROLS & ELECTRICAL CORPORATION

Industrial Automation and Control Systems Integration

Solutions, Our Passion!
FIRE / EARTHQUAKE DRILL CHECKLIST FORM
Title:
Drill conducted by:
Place of drill:
Date of drill:
Duration of drill:
Total number of participants:
Time Fire/Earthquake Started: Time of Fire/Earthquake out:

Time Evacuation started: Time Evacuation ended:

Time responder/s arrived: Time responder/s out:
Nearest Hospital Emergency number: Number of ambulance needed:
Head count per department Male Female Total Name of victims Type of Injury
Engineering
Safety
SMS
Sales
SCM
QMD
Accounting

*General Evaluation YES NO REMARKS

The drill participants executed the duck cover and hold technique during the alarm phase or while the
alarm system is being sounded

The drill participants waited for the alarm system to stop before the evacuating

The drill participants followed their evacuation routes to the evacuation area or assembly point

The drill participants covered their heads while vacating the building

A headcount was conducted while in the evacuation area

The participants stayed in the evacuation area until the drill was terminated

There is a first aider standby during the Fire / Earthquake drill

Facilitated by: Checked by: