Health and Safety Drill
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Location Name
Organization Name
Date of Report
MM
/
DD
/
YYYY
Report Completed By
# of Drill Conducted in the Month
Time of drill
Time
:
Type of Drill
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Person Conducting Drill
Date of Drill
MM
/
DD
/
YYYY
Length of Drill
# of people participated
# of people not present
Method of notification
Condition simulated / problems
Was an alarm sounded for the drill?
Clear selection
Which areas of the facility were affected?
Was an evacuation of these areas completed?
Clear selection
If an evacuation was not completed, explain why.
Effectiveness of the Drill
Unsatisfactory
Satisfactory
Clear selection
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