Emergency Drill Reporting Form - DOC

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					                                      Tacoma Public Schools



Emergency Drill Reporting Form
School:                                              Date:              # Staff (ALL or Attach List):

Person Completing Form:                              Title:             # Students Involved:

Time Alarm Sounded:       Time Drill Concluded:      Fire Drill –Min.   Emergency Procedures prior
                                                     To Evacuate:       training this year:
                                                                        Staff: Y N Students: Y N

                             Notification/Alert      Weather
Type of Drill:               Method:                 Conditions:                Participants:
 Fire/Evacuation             Bell or                  Clear                     School Admin.
 Lockdown                     Buzzer                   Cloudy                    Teachers/Paras
 Modified                    Intercom                 Rain                      Custodial
  Lockdown                    Phone                    Rain & Wind               Students
 Shelter-in-Place            Voice                    Windy                     School Security
 Earthquake                  Siren                    Snow / Sleet              Police
 Other __________            Other                    Hail                      Fire
  _______________            ___________                                           Other ________
                                                     Check All That
Timing of Drill:             Problems Found:         Apply                      Lockdown:
   Before School             Alarm not              Staff Unsure of           Unable to Lock
   During Classes             Heard                   Responsibilities           Doors
   Passing Time              Students               Weather Issues            Doors left Open
   Recess                     Confused               Students                  Lights left On
   Lunch Period              Congestion in           Unaccounted               Windows not
   Assembly                   Hallways               Disability                 Covered
   After School              Prolonged               Evacuation                Windows left
   Other: ________            Evacuation             Radio                      Open
                              Student                 Communication             Students Visible
Mapping and ICS:               Cooperation            Network /
 Mapping                     Supplies                Computer
  System Used                 Transport’n            Noise Issues
 Incident                    Interagency            Incident
 Command System                Communica-              Command
 Used                          tion                   Other _______


Explanation of Problems: ________________________________________________
________________________________________________________________________
Plan for Improvement: __________________________________________________

_______________________________________________________________________




b5efa225-dc95-4f5c-b422-248750bb14ef.docReturn   Copy to Safety Department                       2/3/2011
               10/12/2010

				
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