HSEQ Weekly Emergency Drill Feedback Date: Shift Group: Warden: Deputy Warden: EXERCISE: PARTICIPANTS NAMES Sr. Name P. No Unit Actual Shift Group Sign 1HSEQ 2HSEQ 3Ammonia 4Urea 5Urea 6Utilities 7B&S 8B&S 9Laboratory Fire squad first activity at: Fire Siren Sounded at: Operator activity started at: EVALUATION / GRADING OF FIRE FIGHTING ACTIVITIES SR# ACTIVITIES POINTS GIVEN BY (Max = 10) Observer 1 Observer 2 HSE Observer 01Scenario Was Clearly Communicated... 02Fire Truck Reached at hrs... 03Timely Assembling of Fire Squad at hrs. 04Warden/ Deputy Warden Briefed... 05In Case of Electrical Fire in Building... 06Squad Use of PPE's was appropriate... 07Rescue Done in Safe Manner... 08Warden & Team Communication... 09Firefighting Team Position... 10Fire, Ammonia, Chlorine or chemical Leak... 11Use of Rescue Equipment... 12Under Wind, Plant / Building Prevented... 13Ambulance Was Called & Reached at ... 14Firefighting Steps were in accordance... 15Briefing & Debriefing Done by Warden. Total Score (max. 150) Cumulative score = (A+B+C)/3 OBSERVERS FEEDBACK Observer 1 Name: OBSERVATIONRECOMMENDATIONAction Narration (Target Date)Responsibility Select Unit... HSEQ Ammonia Urea Utilities B&S Laboratory Mechanical Electrical Instruments + Add Observation Observer 2 Name: OBSERVATIONRECOMMENDATIONAction Narration (Target Date)Responsibility Select Unit... HSEQ Ammonia Urea Utilities B&S Laboratory Mechanical Electrical Instruments + Add Observation HSE Observer Name: OBSERVATIONRECOMMENDATIONAction Narration (Target Date)Responsibility Select Unit... HSEQ Ammonia Urea Utilities B&S Laboratory Mechanical Electrical Instruments + Add Observation Submit Drill Report to Google Sheet
