BUILDING EVACUATION CHECKLIST Building No: Date: Time of Alarm Time of Complete Name of Chief or Deputy Chief Warden: Building Evacuation Floor/Lvl Name/s Area Cleared Comments YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO Are all exits assigned/Secured Any Occupants with Special Needs YES NO Details/Location: YES NO Any occupants refuse to Details/Location: Any person injured or stuck YES NO Details/Location: YES NO Arriving Emergency Service Crews briefed (if applicable) NOTES:
BUILDING EVACUATION CHECKLIST Building No: Date: Time of Alarm Name of Chief or Deputy Chief Warden: Time of Complete Building Evacuation Floor/Lvl Name/s Area Cleared Comments YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO Are all exits assigned/Secured YES NO Any Occupants with Special Needs YES NO Details/Location: Any occupants refuse to YES NO Details/Location: Any person injured or stuck YES NO Details/Location: Arriving Emergency Service Crews briefed (if applicable) YES NO NOTES:
CW_EVACUATION_CHECKLIST.docx