Emergency Response Drill / Exercise Evaluator Worksheet (See ES&H Manual Chapter 3510 Appendix T2 Emergency Response Drills/Exercises – Process Steps)

Drill Title:
Drill / Exercise Owner:			Exercise Coordinator:
Contact Information:			Contact Information:
Evaluator Name:			Date of Exercise:
Contact Information:			Location of Exercise:
Evaluator Instructions:			Special Instructions:
1) Observe drill 2) Check appropriate box for task “Met” or “Not Met” 3) Provide feedback for each task description as appropriate 4) Submit completed form to Exercise Coordinator
Step #	Task Description	Met		Not Met	Comments

Evaluator Signature: ________________________________________ Date _________________

Drill Title:

Date of Exercise:

Evaluator:

Evaluator Notes or Feedback:

Evaluator Signature: ________________________________________ Date _________________

Form Revision Summary

Rev .1 – 01/28/21 – Updated TPOC and division name, no approval needed.

Rev 0 – 02/25/13 - This is new content

ISSUING AUTHORITY	FORM TECHNICAL POINT-OF-CONTACT	APPROVAL DATE	REVIEW REQUIRED DATE	REV.
ES&H Division	Tina Johnson	02/26/13	01/28/26	.1

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