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Emergency Evacuation Checklist Form Template

Streamline Your Safety Protocols with Our Evacuation Checklist

When emergencies strike, having a clear evacuation plan is vital for safety. This Emergency Evacuation Checklist Template helps workplaces and organizations implement efficient escape protocols, ensuring that everyone knows their role in a crisis. With this template, you can create tailored checklists, enhance employee preparedness, streamline communication during emergencies, and meet safety compliance standards-all while reducing stress and confusion. Get started with our live template to see how it works.

Use this Template (FREE) Live Preview
Facility name
Site address
Primary evacuation coordinator
Primary contact phone
Date of check
Are fire or evacuation alarms functional and audible in all areas?
Yes
No
Are visual alarms present where required?
Yes
No
Not applicable
Emergency communication methods available
Public address system
Two-way radios
Text or email alerts
Manual alarm pull stations
Phone tree
Other
Please Specify:
Evacuation maps are posted in common areas
Yes
No
Exit routes are free of obstructions
Yes
Partially
No
Not applicable
Exit doors open easily in the direction of travel and are not locked
Yes
No
Not applicable
Assembly point(s) are designated and clearly marked
Yes
No
A headcount/accountability method is defined
Yes
No
Accountability method used by your site
Roll call by supervisor
Tag or badge collection
QR or app-based check-in
Departmental check-in
Visitor log reconciliation
Other
Please Specify:
List of individuals requiring assistance is current
Yes
No
Not applicable
Refuge areas (if applicable) are identified and communicated
Yes
No
Not applicable
Helpers/buddies are assigned for those needing assistance
Yes
No
Not applicable
Procedures for shutting down critical equipment are documented
Yes
No
Not applicable
Responsible persons for critical shutdown are identified
Yes
No
Not applicable
Have occupants received evacuation training in the past 12 months?
Yes
No
Not applicable
Date of last evacuation drill
Floor wardens/marshals are assigned and trained
Yes
No
Not applicable
Evacuation plan is current and accessible to all occupants
Yes
No
Not applicable
Condition and visibility of exit and directional signage
Poor
Below average
Average
Good
Exceptional
Evacuation maps reflect the current layout
Yes
No
Not applicable
Facility emergency phone number
External assembly point description or address
Overall evacuation readiness
Poor
Below average
Average
Good
Exceptional
Outstanding issues requiring follow-up
Prepared by
Date of completion
I confirm the information provided is accurate to the best of my knowledge
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustrating an emergency evacuation checklist with various safety icons and a clear layout for organization.

When to use this form

Use this form before drills, during fire season or extreme weather, and after layout or staffing changes. Safety officers, facility managers, and team leads can capture routes, roles, and assistance needs so everyone knows what to do. It is also helpful for schools, clinics, warehouses, and offices with visitors or contractors. To spot hazards ahead of time, pair it with the Job safety analysis form. Check training and readiness with a Safety culture survey form, and let staff flag blocked exits or alarm faults using the Workplace safety and concerns form. The result is a current, shareable evacuation checklist template your team can act on.

Must Ask Emergency Evacuation Checklist Questions

  1. What are the primary and secondary exit routes for each area?

    Listing two routes reduces bottlenecks if a corridor is blocked or smoke-filled. It also prompts you to verify signage and lighting along each path.

  2. Where is the outdoor assembly point for each department, and what is the target headcount time?

    Clear locations prevent crowding and speed roll calls. A time goal helps you measure drills and improve until everyone arrives safely and fast.

  3. Who is responsible for sweep checks, headcounts, and shutting down critical equipment?

    Named roles remove confusion during an alarm. Assigning backups keeps the process moving if a primary contact is absent.

  4. Which occupants need assistance to evacuate, and who are the assigned helpers and backups?

    Capturing mobility, medical, or language needs ensures timely support for employees, students, contractors, and visitors. Documented helpers and alternates reduce delays and meet duty-of-care requirements.

  5. What hazards along the route (chemicals, hot work, energized equipment) require isolation before evacuation?

    Noting these risks lets you pre-plan lockout, staging, and safe detours. If you manage welding or cutting, align procedures with your Hot work permit form.

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