Emergency Evacuation Checklist
Site Location
JOB No:
Date
 -
Day
 -
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Name
First Name
Last Name
General Questions
Rows
YES
NO
N/A
COMMENT
Have you been inducted to this site?
1
2
3
Do we have first aiders on site who are they?
4
5
6
Location of the nearest site First-Aid Kit (BIG)
7
8
9
Location of the nearest Site Fire Extinguisher (BIG)
10
11
12
What is this site address?
13
14
15
How do you know when there is an emergency happening?
16
17
18
Closest Hospital?
19
20
21
Scenario
Please Select
A heart attack
Gets hit by a vehicle
Abusive public
Abusive Driver
Walks away from there stop/go point
Gets hit by a vehicle
Walks away from an open hole on the footpath
Car breaches stop/go point
Scenario
Rows
YES
NO
N/A
COMMENT
Do the crew know who is in charge if something happens to you?
22
23
24
Do the crew know what number to call for emergency Services?
25
26
27
Do the crew know where the assembly point is?
28
29
30
Will you send someone to a location to wait for emergency services?
31
32
33
What could we have done better?
34
35
36
Signature
Managers Signature
Submit
Should be Empty: