ISSUED DATE: NOVEMBER 30, 2017

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TOYOTA NUEVA ECIJA INC.

Emergency Drill Report Form
Prepared by: Harvey Sebastian, AOSHP Date:

Attach to this form a list of all staff who participated in the drill, and any visitors participating.

Time Alarm Sounded: Time Drill Concluded: Time to Evacuate:

Type of Drill: Notification / Alert Method: Weather Conditions:

 Fire / Evacuation  Bell or Buzzer  Clear

 Lockdown  Enhanced Alert System  Cloudy
 Modified Lockdown  Intercom  Raining
 Bomb Threat  Phone  Rain and wind
 Earthquake  Voice Notification  Windy
 Terror Attack  Siren
 Medical Emergency  Other:
 Oil/Chemical Spill ______________
 Weather Emergency
 Other:
__________________

Participants: (check all that apply) Situation at Start of Drill:

 Senior Management  Before Business Hours

 Safety Personnel  During Business Hours
 Employees/Staff  Peak Business Hours
 Security Officers  Lunch Time
 Law Enforcement  After Business Hours
 Fire Department  Other:
 Emergency Medical _______________
Services
 Other
___________________

Management previously trained Employees previously

on emergency procedures this trained on emergency
year? procedures this year?
 Yes  Yes
 No  No
Incident Command System Incident Commander: Operations Chief:
Used?

 Yes
 No

Emergency Drill Reporting Form (Cont’d)

1
EMS-F-22 EMERGENCY DRILL REPORT FORM REV.00 DATE:
ISSUED DATE: NOVEMBER 30, 2017
Problems Encountered: (Check all that apply)

 Congestion in hallways  Radio communication problems

 Alarm not heard  Network / computer problems
 Employees unsure of what to do / proper  Noise impedes communications
 Staff unsure of responsibilities / response  Personnel not out of sight (lockdown drill)
 Weather-related problems  Long time to evacuate building
 Unable to lock doors  Personnel not serious about drill
 Windows not covered  Improper or unavailable supplies (SiP)
 Windows left open  Confusion
 Doors left open  Doors or exits blocked
 Lights left on  Transportation
 Personnel not accounted for / attendance  Interagency miscommunications
 Difficulties with evacuation of disabled  Incident command problems
personnel, customers or visitors  Other:
 Personnel unaccounted for (note # below) ____________________________
_________________________________
_

Area that Remarks

was simulated and checked: (Note if there are special simulations done, and the condition of
the area)

Hazardous Waste Storage Area

STP / Electrolysis

Oil Water Separator

Material Recovery Facility

Glass Panels

Paint booths

Generator Sets

Mitigation / Plans for Improvement: (check all that apply and explain below)

 Additional management training  Cooperative planning with responders

 Additional staff training  Revised emergency procedures
 Address need for additional equipment  Other:
 Improved emergency supplies

Explain corrective efforts here:

2
EMS-F-22 EMERGENCY DRILL REPORT FORM REV.00 DATE:
 ISSUED DATE: NOVEMBER 30, 2017
Type of Drill: Oil / Chemical Spill Drill, March 2, 2021

HARVEY SEBASTIAN
Safety Officer

3
EMS-F-22 EMERGENCY DRILL REPORT FORM REV.00 DATE:
ISSUED DATE: NOVEMBER 30, 2017
Type of Drill: Earth Quake Drill December 10, 2021

HARVEY SEBASTIAN
Safety Officer

4
EMS-F-22 EMERGENCY DRILL REPORT FORM REV.00 DATE:
ISSUED DATE: NOVEMBER 30, 2017
Type of Drill: Fire Drill August 25, 2021

HARVEY SEBASTIAN
Safety Officer

5
EMS-F-22 EMERGENCY DRILL REPORT FORM REV.00 DATE: