APIMS-REC-TM-11 Mock Drill Report Updated

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Doc. No.

: APIMS-REC-TM-06
On-Site Emergency: Mock Drill
Rev. No. & Dt.: 01 / 05.01.19
Report and Evaluation
Page 1 of 4

1. Date: ________________.

2. Location: __________________________________

3. Type of Emergency / Incident: _________________________________________________

4. Any other relevant information related to conduct of mock drill: _______________________

_________________________________________________________________________.

Details of key personnel who were involved in the emergency response mock drill:

Sl.No. Description of Responsibility Name of the personnel Remarks


1 Incident Controller
2 Communication Coordinator
3 Fire and Rescue Coordinator
4 Medical Coordinator
5 Observer -1
6 Observer -2

Events:

Sl.N
Events Time Observations
o.
A Communication
Mode of call:
1 Siren

2 Name of the caller:


Announcement on PA (Public
3 Address) system:

4 Siren sounded:

5 Communication to Fire Station:


Is communication given to
neighbouring organisations? If yes,
6
mention the name of the
organisation.
B Response Time

Page 1 of 4
Doc. No.: APIMS-REC-TM-06
On-Site Emergency: Mock Drill
Rev. No. & Dt.: 01 / 05.01.19
Report and Evaluation
Page 2 of 4

To reach at Safe assembly point:

1 a) Senior management staff:

b) Other staff:

2 Arrival of Ambulance:

Arrival of Fire Wardens (Internal


3 Resources):

C Action by Staff

1 Electrical Isolation required:

2 Equipment isolation required:

3 Water spray/ extinguisher / foam used:

D Fire and rescue coordinator

1 Proper approach:

2 Extinguisher, hose, spray operations:


Help sought by the operating staff (in
3 extinguishing the fire):

Monitoring and Evacuation of people


by the coordinators; ensuring no
4 persons left out within building,
especially in the vicinity affected area:

E Assembly Point

All persons (not required for


1 emergency response) are to assemble
at Assembly Point:

Total No. of persons present in


2 Factory:
Staffs
Frontliners
Visitors
Customers
Security

Page 2 of 4
Doc. No.: APIMS-REC-TM-06
On-Site Emergency: Mock Drill
Rev. No. & Dt.: 01 / 05.01.19
Report and Evaluation
Page 3 of 4

Drivers
Total:-

3 Reporting to Incident Controller:

F Medical

1 Ambulance Report:

2 Other Action:

3 Victim condition:

G Use of PPEs

1 Breathing Apparatus Set:

2 Fire Suit:

3 Safety Kit:

4 Other tools:

H Transport

Number of vehicles reported at site –


1 that were not required for responding
to emergency:

Number of vehicles reported at site –


that were required for responding to
2 emergency – for transporting people to
safe place:

I Mutual Aid response

1 Call time:

2 Help extended:

J Other Observations

1 Speed of work:

2 Confidence in work:

Page 3 of 4
Doc. No.: APIMS-REC-TM-06
On-Site Emergency: Mock Drill
Rev. No. & Dt.: 01 / 05.01.19
Report and Evaluation
Page 4 of 4

3 Knowledge of area:

4 Panic situation:

5 Root cause of incident

Conclusion and recommendations:

Sl. Resp. & Tgt.


Recommendation Action Proposed Status
# Dt.

Name & Sign of Observer Name & Sign of Plant head

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