Republic of the Philippines

Province of Misamis Occidental

Municipality of Tudela

Municipal Disaster Risk Reduction and Management Office

EARTHQUAKE DRILL EVALUATION FORM

Place of Drill: Date/Time:

Location (Specific): Evaluator:

1. Is the siren/alarm LOUD enough to be heard by all the drill participants?

Yes/No. If NO, please elaborate _________________________________________________________
2. Did the drill participants PRACTICE the “Duck, Cover, and Hold” technique
during the ALARM PHASE (while the siren/alarm is being sounded)? Yes/No. If
NO, please elaborate
__________________________________________________________________________
3. Did the drill participants a) EVACUATE during the ALARM PHASE b) WAITED for
the siren/alarm to STOP before evacuating c. Others, please elaborate
_____________________________________________________________________________________________
4. Did the drill participants FOLLOW their designated routes to evacuation area?
Yes/No. If No, please elaborate _________________________________________________________
5. Did the participants a) RUN b) WALK CASUALLY or c) WALK FASTER than
normal during the EVACUATION PHASE? Please specify, a, b, or c
_____________________________________________________________________________________________
6. Did the drill participants BRING any FIRST AID KIT or any item noticeable during
EVACUATION PHASE? Yes/No. Please elaborate
______________________________________
7. Did the drill participants CONDUCT head count during the HEAD COUNT PHASE?
Yes/No. If NO, please elaborate _________________________________________________________
8. Is the evacuation area BIG enough to accommodate the evacuees? Yes/No. If NO,
please elaborate
__________________________________________________________________________
9. Any other problem observed during the drill that might need to be addressed?
Please elaborate
__________________________________________________________________________
10. How long did it take the drill participants to EVACUATE the building and to
REACH the designated Evacuation Area?
_______________________________________________________
11. Did the drill participants a) STAY in the Evacuation Area b) MOVE to other place
c) GO BACK to the building without instruction? Please specify a, b, or c
_____________________________________________________________________________________________
 12. Observed number of drill participants:

No. of Participants Male Female Total

No. of Teaching Personnel
No. of Non-teaching
Personnel
No. of learners

13.Common issues and concerns encountered during the actual conduct of drill:

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

COMMENTS and RECOMMENDATIONS:

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

__________________________________________

Evaluator
Signature over Printed Name

__________________________________________
Conforme/School
Signature over Printed Name