Emergency Assembly Checklist
Complete this checklist to verify personnel safety and procedures during an emergency assembly or drill.
Assembly Coordinator Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Assembly
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Assembly Location
*
Department or Team
*
Please Select
Administration
Operations
Maintenance
Security
IT
Other
Personnel Headcount Confirmed?
*
Yes
No
List of Assembled Personnel
*
Checklist: Select all that have been completed
*
All personnel accounted for
Area cleared and safe
First aid administered if needed
Emergency services contacted (if required)
Evacuation routes clear
Assembly point secure
Other
Were there any missing or injured persons?
*
No, everyone is safe and present
Yes, missing persons
Yes, injured persons
Please provide details about any missing or injured persons, or other incidents (if applicable)
Additional Notes or Comments
Signature of Assembly Coordinator
*
Submit Checklist
Submit Checklist
Should be Empty: