Mock Emergency Drill Worksheet

ABC Hospital


Disaster Planning Form to create a Fire or Disaster DRILL

Disaster Planning (DP) Coordinator or Safety Coordinator____________________________

DP Veterinarian ________________________

DP Veterinarian ______________________

Date of Disaster Drill ____________________

Local agency involved: _________________________________________________________

Local agency involved: _________________________________________________________

Kept a secret from the team, a surprise?  Yes/No

Created with the team’s knowledge   Yes/No

Appts light for the morning/afternoon/evening to create time and allow for participation.. Yes/No

 Appt scheduler properly marked off and allow for phone to be turned over    Yes/No

Poster created for the front door apologizing for inconvenience,

explaining the VITAL TRAINING…Yes/No

Stuffed animals brought in for demonstration purposes….Yes/No

Identify location for all employees and clients to meet at the onset of a disaster    Yes/No

Create a map of the Hospital/Facility and post the location of meeting place    Yes/No

Location updated in all emergency literature to include Employee Handbook and OSHA Training   Yes/No

Ground Rules for Emergency Planning discussed at a previous Team Meeting    Yes/No

Evacuation Plan written with protocols and local/state contacts and phone numbers….Yes/No

Evacuation Plan discussed at previous Team Meeting and with all New Hires….Yes/No

911, allow experts to tend to the patients, take care of all people first, all employees have knowledge of this  911 PRIORITY……Yes/No….

Print off “Heroes Need Not Apply” article and review the team…Yes/No

911 Protocol placed in Employee Handbook and OSHA training….Yes/No

Evacuate Building, create communication back up protocol….Yes/No

List of all employees working at the time     Yes/No

List of all employees not working at the time .Yes/No

List of all clients and their pets that need to be contacted…Yes/No…..

How to generate a list without access to computer? Problem solved, back up to website accessible offsite…Yes/No

Things to cover;

_____ Safety of all people, first

_____ No running, remain calm

_____ Has 911 been contacted?

Who are we missing?_____________________________________________________________

Who is designated to make decisions during an emergency? _____________________________

First aid of people, First Responders, First aid Kit? ___________________________________________

Evaluate the evacuation of patients after people are accounted for

  1. Enough leashes/carriers
  2. Critical patients
  3. Temporary housing
  4. Relationships with neighboring veterinary clinics
  5. Other
  6. Other

Evaluate the consideration of business continuing to run

  1. Communication
  2. Electricity (generator, batteries, flash lights)
  3. Computer database and back up
  4. Supplies
  5. Move to temporary facility
  6. Insurance agents contacted
  7. Other
  8. Other


What went well?

What can we have done better?

How will we make it better, next time?

What else?


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