Emergency Response Protocol Audit Form
Assess and document compliance with emergency response procedures.
Auditor Full Name
*
First Name
Last Name
Auditor Email Address
*
example@example.com
Audit Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Facility/Location Name
*
Department or Area Audited
*
Type of Emergency Protocol Audited
*
Please Select
Fire Safety
Medical Emergency
Evacuation Procedures
Hazardous Material Spill
Security Threat
Other
Protocol Compliance Assessment
*
Rows
Compliant
Partially Compliant
Non-Compliant
Emergency exits clearly marked and unobstructed
1
2
3
Staff aware of emergency procedures
4
5
6
Emergency contact information available
7
8
9
Equipment (alarms/extinguishers) accessible and functional
10
11
12
Drills conducted as scheduled
13
14
15
Overall Preparedness Rating
*
1
2
3
4
5
Observations and Notes
Immediate Actions Required
Responsible Person for Follow-Up
Target Date for Follow-Up Actions
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Audit
Should be Empty: