Evacuation Notification Form
v2.1
Please complete the form below and attach a copy of the ‘Evacuation Checklist’ if completed during
the evacuation to support continued improvement of our emergency response procedures.
Campus: Albury-Wodonga
Building No.
Building Name:
Evacuation Date:
Reason for Evacuation:
Time:
 Scheduled Trial  Unplanned alarm activation
Details:
Approximate time taken to evacuate the building:
Details of any problems experienced during the evacuation:
Action required to amend Emergency Plan?
Any other comments?
Name:
Telephone:
Forward completed form:
Submit form
Date:
Further information:
Manager, Work Health & Safety (Facilities)
Division of Facilities Management
Email [email protected]