Attachment II

 

 

UNIVERSITY SAFETY OFFICE

EVACUATION PROCEDURE EVALUATION

 

 

Building Location_________________ Department_______________________________

 

Building Manager: __________________________ Date: _____________ Time:_______

 

________________________________________________________________________

Activity                                                            Sat/Unsat                                Remarks

 

 

PROCEDURES

 

Evacuation Time

________________________________________________________________________

Level of Occupant Participation

________________________________________________________________________

Effectiveness

________________________________________________________________________

Head Count/Accountable

________________________________________________________________________

 

 

STAFF EFFICIENCY

 

Announcements

________________________________________________________________________

Evacuation Control

________________________________________________________________________

Reporting to UPD

________________________________________________________________________

Fire Extinguisher/Hose Use

________________________________________________________________________

Assist Emergency Response

________________________________________________________________________

 

 

RESPONSE TIME

 

Time of UPD

________________________________________________________________________

Time of S.M.F.D

________________________________________________________________________

 

 

 

 

SYSTEMS

 

Alarms Aural

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Visual

________________________________________________________________________

Notification to UPD - Alarm

________________________________________________________________________

Telephone

________________________________________________________________________

Doors Closed

________________________________________________________________________

HVAC Shut Down

________________________________________________________________________

Emergency Lighting

________________________________________________________________________

Other

________________________________________________________________________

 

 

BUILDING CONDITIONS

 

Clear Evacuation Routes (No Obstructions)

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Training of Personnel

________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UPPS Form No. 04.05.04-EHSRM-10-08