Basic Information
Hospital Name
Department / Ward
Date of Drill
Time
Drill Coordinator
Contact Number
Evacuation Drill Details
Type of Emergency Simulated
Total Number of Participants
Departments/Wards Involved
Areas Evacuated
Total Evacuation Time (mm:ss)
External Agencies Involved
Observations & Outcomes
What Went Well?
Challenges / Issues Noted
Actions Taken During Drill
Improvement Plan
Recommendations for Future Drills
Person Responsible for Follow-Up
Date for Next Review
Sign-Off
Completed By
Date