Emergency Plan Manual

EMERGENCY EXERCISE EVALUATION FORM Page 3 of 3 SUMMARY CONCLUSIONS AND ACTION PLAN Brief Summary of Events: Issue/Conclusion Needed Action(s) By Whom By When Other: EVENT NOTIFICATION No Problem Identified COMMUNICATION No Problem Identified RESOURCE MOBILIZATION AND ALLOCATION No Problem Identified SAFETY AND SECURITY No Problem Identified STAFF RESPONSIBILITIES No Problem Identified UTILITIES MANAGEMENT No Problem Identified PATIENT MANAGEMENT No Problem Identified EVACUATION No Problem Identified EVALUATION OF THE EFFECTIVENESS OF IMPROVEMENTS THAT WERE MADE IN RESPONSE TO CRITIQUES OF A PREVIOUS EXERCISE OTHER Evaluation completed on:______________ by:________________________________ _____________________________________________________________________