Unannounced Emergency Procedures
2021
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1. Date of Event
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2. Location
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3. Time of the Event 
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4. Event
5. Type 
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6. Description of Emergency / Drill
7. Compliance
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
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Comments 
8. Were there any injuries during the event?IF "YES", then an Incident Report needs to be completed.
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9. Analysis and Comments:
10. Are there areas needing improvement?
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Explain: 
11. Corrective Action
12. Corrective Action Plan 
13. Do personnel require additional education or training to improve performance? 
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If YES identify needs below: 
14. Did the actions taken accomplish the intended result? 
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15. Person Completing the report: 
16. Date Reviewed 
MM
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DD
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YYYY
NOTE: This Emergency /Evacuation Report is to be completed and sent to the Executive Director or
designee following any emergency or evacuation, actual event or unannounced drill.
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