AL-JAZIRAH INDUSTRIAL PROJECTS CO

GENERAL TRADING & CONTRACTING

Ref. HSE- Practice Drill Record

FORM 09/01

TYPE OF DRILL:
Please fill out the information below, as thoroughly as possible. Keep a copy for your personal records, and
forward the original to the AIGTCC HSE Corporate Department.
Division/Project: Drill Location:
Date: Time Started: Time Ended:

Good Fair Poor

Staff members that participated and their roles
Personnel Name Role
Response
Effectiveness of
Procedures
Speed of
Evacuation
Communication
during Drill
Overall
Effectiveness All participants attendance must be recorded in HSE Training Record

Person Conducting the Drill: Notification Method Used:

Did all Employees assemble in Emergency Assembly

Point (If no, note locations)?
Number of Employees Evacuated: Number of Staff Evacuated:

Time Consumed to Complete Time Consumed to Complete the

Evacuation (only): Whole Exercise:
Weather Conditions:

Problems Encountered:

Items to Improve for next Exercise:

HSE Staff Project Manager

Name:

Signature &
Date:

Received date: Reviewed Date: Date:

Comments:
Departmen
For HSE

t USE