Emergency Drill Form Step 1 of 2 50% Date(Required) MM slash DD slash YYYY Person Completing Drill:(Required) First Last Site Address:(Required) Email:(Required) HiddenType of Drill:(Required) Bomb Threat- Telephone/Suspicious Package Fire Medical Power Failure Severe Weather Violent Behavior Type of Drill:(Required) Fire Medical Power Failure Severe Weather Violent Behavior Bomb Threat- Telephone/Suspicious Package Natural Disater Utility Failure Time Drill Started:(Required) Hours : Minutes AM PM AM/PM Time Drill Ended:(Required) Hours : Minutes AM PM AM/PM HiddenWhere program participant's involved:(Required)YesNoWhere program participant's involved:(Required)YesNoExplain Participation(Required)MEDICALIndicate, what type of medical emergency was stimulated:(Required)VIOLENT BEHAVIORIndicate, what type of violet emergency was stimulated:(Required)BOMB THREATIndicate who was informed (by the receiver of call or finder of package) of the threat?(Required) HiddenWere individuals moved to a safe location and all accounted for?(Required)YesNoHiddenWas there a need for evacuation from the building?(Required)YesNoWhere program participant's involved:(Required)YesNoWas there a need for evacuation from the building?(Required)YesNoWere people left in the building who did not move to a safe location?(Required)YesNoHiddenWere people left in the building who did not move to a safe location?(Required)YesNoDescribe:(Required)HiddenWere emergency procedures followed?(Required)YesNoWere emergency procedures followed?(Required)YesNoDescribe:(Required)Describe how staff responded to the drill:(Required)Do changes needed to me made to the policy/procedures?YesNoHiddenDo changes needed to me made to the policy/preocedures??(Required)YesNoDescribe changes:(Required)I attest that the information provided is true to the best of my knowledge.(Required)