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EVACUATION DRILL FORM
CHECKLIST
Use the legend below to rate the overall performance of the Boys & Girls Club staff during this fire drill.
1 = Poor
2 = Below average 3 = Satisfactory
4 = Above average 5 = Excellent
When the fire alarm is sounded:
- The front counter person (speaking clearly, calmly, and slowly) makes the following announcement, “This is a fire drill. Everyone please stop what you are doing and walk to the nearest exit!” Boys & Girls Club Staff will direct you”. Rating: Comments:
- Boys & Girls Club Staff stationed throughout the building instruct members to stop what they are doing and set any Boys & Girls Club equipment they are using down immediately. Rating: Comments:
- Boys & Girls Club staff opens and holds open exit doors, pointing (as a flight attendant would to emergency exits) people inside in the direction of the “designated assembly area”. Rating:_ Comments:
- Boys & Girls Club staff inside the building direct (by speaking in a clear calm, purposeful voice, gesturing and pointing) everyone in the building to walk to the nearest exits. Rating: Comments:
5. Boys & Girls Club staff outside direct foot traffic exiting the building to the “primary designated assembly area”. or the “secondary assembly area” .
Rating Comments
- Designated supervisors inside perform a sweep of the building to ensure that everyone has evacuated all areas of the building.
Rating: Comments:
- Boys & Girls Club supervisor in charge for the day is stationed near the front door, monitoring foot traffic. Rating: Comments:
- Boys & Girls Club front counter personnel on duty bring “Emergency Evacuation” attendance forms with clipboards and writing utensils, to the “primary designated assembly area”.
Rating: Comments:
- Boys & Girls Club supervisor second in command proceeds to the designated area and supervises occupants while on the field, making announcements when necessary. Rating: Comments:
- Boys & Girls Club staff supervises everyone waiting at the “designated assembly area” until official announcements are made.
Rating: Comments:
- Boys & Girls Club front counter personnel record the names of persons authorized to pick up members as well as the time of departure.
Rating: Comments:
- Upon clearance from the fire department, the supervisor in charge allows 20 people at a time, to re-enter the building through the front door.
Rating: Comments:
Fire Drill Evaluator’s name (print) Date
Score: (circle one) Pass Fail Repeat date
Evacuation Drill Evaluator’s signature Date
