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ABC _ Unannounced Emergency Procedures - 2024

1.Date of Event(Required.)
Date
2.Location(Required.)
3.Time of Event(Required.)
4.Event(Required.)
5.Type(Required.)
6.Description of Emergency/Drill(Required.)
7.Compliance(Required.)
Yes
No
All persons are present and accounted for
Were all persons present/compliant with the Emergency/Evacuation?
All persons met at designated area(s)
All areas checked
Did the response to the emergency require and evacuation
Evacuation completed in a timely and orderly manner
8.Were there any injuries during the event? If "yes", then an Incident Report needs to be completed.(Required.)
9.Analysis and Comments(Required.)
10.Are there areas needing improvement?(Required.)
11.Explain
12.Corrective Action(Required.)
13.Corrective Action Plan
14.Does personnel require additional education or training to improve performance?(Required.)
15.If yes, identify the needs below
16.Were the actions taken accomplish the intended result?(Required.)
17.Name of Person Completing this Report(Required.)
18.Date Reviewed(Required.)
Date
19.NOTE: This Emergency/Evacuation Report is to be completed and sent to the Executive Director or
designee following any emergency, evacuation, actual event or unannounced drill.(Required.)