Emergency Drill & Evaluation Form

Document, evaluate, and improve emergency response capabilities

📋 Drill Information

Drill Date *

Drill Start Time *

Announced? *

Announced

Unannounced

District / Base *

Drill Type *

Drill Frequency *

Drill Coordinator *

Drill Scenario Description *

⏱️ Response Timing

Timing Instructions: Record actual times for each phase. Leave blank if not applicable to this drill type.

Alarm Activated

First Response

Muster Complete

All Clear Given

Total Response Time (min)

Target Time (min)

Target Met? *

Yes

N/A

👥 Participants

Number of Participants *

Key Participants & Roles

🔧 Equipment & Communication

Emergency Equipment Used/Tested

All Equipment Functional? *

Yes - All worked

No - Issues found

N/A

Communication Effective? *

Yes

Accountability Completed? *

Yes

📊 Performance Evaluation

Overall Performance Rating *

✅ Evaluation Criteria - What Was Done Well

Check all criteria that were met satisfactorily or exceeded expectations:

☐Alarm recognition and response

☐Muster/assembly procedures

☐Personnel accountability

☐Communication effectiveness

☐Command structure established

☐Emergency equipment operation

☐Evacuation procedures

☐First aid/medical response

☐Fire suppression techniques

☐Spill containment procedures

☐Well control procedures

☐H2S response procedures

☐Rescue operations

☐External notification procedures

☐Documentation and logging

☐Overall coordination

⚠️ Evaluation Criteria - Needs Improvement

Check all criteria that need improvement:

☐Alarm recognition and response

☐Muster/assembly procedures

☐Personnel accountability

☐Communication effectiveness

☐Command structure established

☐Emergency equipment operation

☐Evacuation procedures

☐First aid/medical response

☐Fire suppression techniques

☐Spill containment procedures

☐Well control procedures

☐H2S response procedures

☐Rescue operations

☐External notification procedures

☐Documentation and logging

☐Overall coordination

What Went Well (Details)

Areas Needing Improvement (Details)

🔧 Corrective Actions & Follow-Up

Important: All identified deficiencies should have corrective actions assigned with owners, due dates, and priority levels.

Corrective Actions Required

Action Owner(s)

Due Date

Priority

High

Medium

Low

Lessons Learned

Training Needs Identified

Procedure Updates Needed

Equipment Repairs/Replacements

📅 Follow-Up & Review

Follow-Up Drill Needed? *

Yes

Observer Names

Observer Notes

Supervisor Review/Sign-Off

Management Comments

AnthroSafe™ Field Driven Safety