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unif iea <br /> Emergency Evacuation Plan <br /> EVACUATION CRITIQUE SHEET <br /> Date: Shift: Start Time: End Time: Total Time: <br /> Evacuation Fire 0 Earthquake 0 Spill 0 Bomb Threat 0 <br /> T e: <br /> Was the Yes 0 Time: <br /> Fire Dept. No 0 By whom? <br /> notified? <br /> Did the guard prevent traffic from entering Yes 0 <br /> or leaving? No 0 Why: <br /> Was location of the emergency identified? Yes 0 <br /> No 0 Why: <br /> Were all personnel accounted for during Yes 0 <br /> roll call? Include all employees, <br /> contractors, truck drivers and visitors. No 0 Why: <br /> Did office employees during off-shift Yes 0 <br /> contact guard in case of emergency? <br /> No 0 Who: <br /> Was there effective communication Yes 0 <br /> between emergency coordinator, <br /> supervisor or alternate? I No 0 Explain: <br /> Did ER members For each no response, identify who is missing which <br /> have available the equipment? <br /> following equipment Alarm Map (Emergency Coordinator) Yes 0 No 0 <br /> with them when Flash light Yes 0 No 0 <br /> reporting to the Full Face Respirator Yes 0 No 0 <br /> emergency center? Coveralls Yes 0 No 0 <br /> Two types of gloves Yes 0 No 0 <br /> First Aid Kit Yes 0 No 0 <br /> Vest Yes 0 No 0 <br /> Other (Identify): <br /> Improvement Actions Responsible Person Completion Date <br /> REVISED December 31,2007 PAGE 24 <br />