Evacuation Drill Response Form
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1Evacuation Drill Response Form
Note: This form must be completed for any fire alarm and scheduled evacuation drill which results in a building evacuation.
For questions contact Risk Management at x2102.
Section 1: General Information
U
Date/Time Evacuation Drill
conducted:___________________________________________________________________
Building Name and SB
Coordinator:_____________________________________________________________________
Person Supervising the Drill:
__________________________________________________________________________
Section 2: Alarm Information
Time Alarm Set-Off: _________a.m. / p.m..
Time Alarm Silenced:_________ a.m./ p.m.
CALL Campus Security x2222 or 951-785-5222?
Yes
No
Was the Alarm Signal received by the Dispatcher
Yes
No
Did Alarm Devices Activate?
Yes
No
Was there any trouble with the initiating alarm devices or alarm panel?
Yes
No
Facilities Response Time:______Minutes.
Security Response Time:__________Minutes.
Section 3: Evacuation Information
U
Evacuation time:_______Minutes
Did everyone evacuate the building?
Yes
No
Did everyone proceed to the predetermined assembly area?
Yes
No
Was the evacuation orderly?
Yes
No
Were there disabled persons requiring assistance?
Yes
No
Please provide observations of failed equipment or other
recommendations:____________________________________________________________________________
ASSEMBLY AREA -- STAY 100 Feet away from the building
Lower Campus Mall
La Sierra Hall
Lower Campus Mall
Administration
Alumni Center
Parking lot
Library
Middle Campus Mall
Middle Campus Mall
Palmer Hall
Ambs Hall
Campus Drive
Angwin Hall
Lower Campus Mall
PSC
Campus Drive
Lower Campus Mall
San Fernando Hall Middle Campus Mall
Calkins
Commons/Bookstore
Lower Campus Mall
School of ED
Middle Campus Mall
Campus Drive
Sierra Towers
Cossentine Hall
Cross to the Parking Lot
Facilities
Parking lot
Sierra Vista Hall
Campus Drive West of parking
Lower Campus Mall
South Hall
Gladwyn Hall
Lower Campus Mall front area
HealthExerciseScience
Field
VAC
Upper Campus Drive
Lower Campus Mall
Zapara
Heritage Way
HMA
Humanities Hall
Middle Campus Mall
**PLEASE RETURN COMPLETED FORM TO THE OFFICE of RISK MANAGEMENT
9/9/2015
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