GSA3697
Evacuation Report/Survey
GSA Form 3697, Evacuation Report/Survey, is a two-page General Services Administration form, Rev. 10/2009. Its header reads To Be Completed by ALL Wardens and Monitors, and the instructions say that following a partial or full evacuation, the Emergency Coordinators and Floor Wardens and Monitors are to complete it.
Thirteen numbered questions cover the date and time of the evacuation, the time elapsed from the alarm until all employees and visitors evacuated, the approximate number of people in the area, whether the evacuation was orderly, whether the fire alarm could be heard and the strobe lights operated, the public address announcement, the outside all clear announcement, hindrances, special duty assignments, the time to return to the floor, whether the evacuation was satisfactory, and suggestions. The back ends with the building floor, the warden or monitor, the preparer's name and signature, the OEP assignment and a telephone number.
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Date and time of evacuation, time elapsed to the nearest minute from the sounding of the alarm until all employees and visitors evacuated, and the approximate number of employees and visitors in your area of responsibility.
Yes or no questions on whether the evacuation was orderly, whether the fire alarm could be heard and whether strobe lights operated, with space for reasons and locations.
Whether a public address announcement was broadcast in a loud, clear manner, with locations and faults if not, and whether an outside all clear announcement was given.
Any hindrances to rapid evacuation, and whether the mobility evacuation personnel assigned to special duties carried out their assignments.
Minutes required for employees to return to their floor, whether the evacuation was satisfactory, and suggestions or comments.
GSA building floor, name of floor warden or monitor, name of person preparing the report, report preparer's signature, OEP assignment and telephone number.
Fill in items 1a and 1b, the date and time of the evacuation.
Item 2 asks for the time elapsed to the nearest minute, item 3 for the approximate number of employees and visitors, and item 11 for the minutes required to return to the floor.
Check yes or no for items 4 to 8, 10 and 12, and fill in the follow-up line where the form asks for a reason, locations or faults.
Describe any hindrances in item 9 and suggestions in item 13. The form says all requested information should be provided, and that additional sheets are recommended for comments if necessary.
Enter the building floor, the floor warden or monitor, the name of the person preparing the report, the signature, the OEP assignment and a telephone number.
The form says floor wardens and monitors forward their completed report to their HSSO.
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Floor wardens and monitors forward their completed report to their HSSO, who forwards all completed reports with a summary report to the Director, Office of Management Services.
The form says all reports are due to the Director, Office of Management Services by Close of Business the day following the evacuation event.
GSA Form 3696 records the command center personnel and occupant emergency team coordinators present for an evacuation and the floors as they report in.
The instructions at the top of the form describe who completes, reviews and receives it.
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The header says it is to be completed by all wardens and monitors. The instructions say the Emergency Coordinators and Floor Wardens and Monitors complete it following a partial or full evacuation.
The form says all reports are due to the Director, Office of Management Services by Close of Business the day following the evacuation event.
The form says HSSOs review all reports for completeness, consolidate multiple reports, prepare an overall summary report, keep a copy and forward everything to the Director, Office of Management Services.
The form says additional sheets are recommended for comments if necessary.
Item 2 asks for the time elapsed to the nearest minute from the sounding of the alarm until all employees and visitors evacuated the area.
