Policy Directive 72
Emergency Management - Superintendents’
Responsibilities and Exercise Management
Appendix 1
Emergency Management Exercise Report Form
Prison:
Date of exercise:
/
/
Time started:
Type of Incident: ie Fire
Time ended:
Type of Exercise: Live
Desktop
Exercise Controller (name and position):
Observers (name and position):
Safety Officer (name and position):
Were Health Services involved?
Yes
No
Who informed Health Services? (name and position):
Manager Health Services on duty (name and position):
Participants (name and position):
Training return attached:
Yes
No
Purpose of exercise: ie to test preparedness in the event of a fire.
Debrief notes:
Exercise report:
Lessons learnt:
Proposed changes to procedures (if identified as a need):
Report submitted by (name and position):
Signed:
Date:
/
/
Policy Directive 72 – Appendix 1 – Emergency Management Exercise Report – v 2.0
Page 1 of 2
Amendment history
Version no and description
Approved
Effective date
1.0 First published
7 November 2012
30 November 2012
2.0 Amended (minor formatting only)
N/A
12 April 2013
Policy Directive 72 – Appendix 1 – Emergency Management Exercise Report – v 2.0
Page 2 of 2