fire drill checklist

1. Plant name
Time Drill initiated
Elapsed Time
Roll call completed time
Drill monitors 1 Name
2 position
Remarks
Yes No
Satisfactory Unsatisfactory
Satisfactory Unsatisfactory
Yes No
Yes No
COMMUNICATION
Method of Drill Activation
PA System
Remarks
Satisfactory Unsatisfactory
Date
ORANGE KALBE FIRE DRILL EVACUATION CHECKLIST
am/pm
Time all occupants evacuated
am/pm
……………………………………………………………………….am/pm
Brief details
In-House Word of Mouth Other: ………………………………………………………
Fire Alarm
Alarm Activation
Description Yes No
Drill Preannounced
Emergency Response Team present for the drill
Security Notified Prior to Drill
Public Address system clearly heard in all areas
All Employees participated and Evacuated
Evacuation was orderly
Electrical Power was turned off
Emergency Power was available
Fire extinguishers taken to Location of fire
Fire Hose Reel Used (Mock test)
Evacuation Performed according to Plan
Emergency Response Team respond according to plan
Rest room were checked for occupants
Missing Persons Identified by roll call
Details of Missing persons communicated to ERT
Visitors Escorted and Accounted for
Special needs persons accomodated
overall response of occupants
Fire alarm clearly heard in all area
Fire zone correctly identified by ERT/ Security gurads
Alarm monitoring Station received alarm
Number of Employees Evacuated Visitors
Employees
Others
Emergency Response Co-ordinator
Name: ……………………………………………………………………………………………. Signature: ……………………………………………………………………………………………..
Plant Manager
Name: ……………………………………………………………………………………………. Signature: ……………………………………………………………………………………………..
HSE Head
Name: ……………………………………………………………………………………………. Signature: ……………………………………………………………………………………………..
Exit Doors operating Properly
Assembly point unobstructed
Exits are clearly Marked
Illumination for assembly point & Exit path
Hydrant pump work condition
PREDRILL ASSESSMENT
Form No: F/OKL/FDC/003:00