CSUDH Evacuation Roll Call Site Attendance Checklist
This file provides a structured checklist for accounting employees during an evacuation at California State University, Dominguez Hills. It ensures that all personnel are accounted for in the event of a disaster. Use this form to streamline the roll call process and enhance safety measures.
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How do I fill this out?
To fill out this form, start by entering the date at the top of the checklist. Next, list the names of the employees in the designated section. Mark the attendance status for each individual to ensure accurate accounting when evacuating.
How to fill out the CSUDH Evacuation Roll Call Site Attendance Checklist?
1
Enter the date at the top of the form.
2
List the employees' names in the provided space.
3
Check the attendance status for each employee.
4
Mark if anyone is missing or injured.
5
Ensure the form is kept accessible during the evacuation.
Who needs the CSUDH Evacuation Roll Call Site Attendance Checklist?
1
Building managers, as they need to ensure employee safety during emergencies.
2
Floor wardens, to account for staff presence and provide reports to authorities.
3
Human resource personnel, to keep track of attendance during evacuations.
4
Safety officers at CSUDH, to maintain compliance with emergency procedures.
5
Emergency response teams who require accurate attendance data during incidents.
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Make the necessary changes directly in the text fields.
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What are the instructions for submitting this form?
To submit this form, email it to the designated safety office at csudh_safety@csudh.edu. Alternatively, you can fax the completed form to (310) 243-3920. If necessary, drop off a physical copy at the safety office located in the Administration Building, Room 130, California State University, Dominguez Hills. Make sure to keep a copy for your records.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates for this form apart from the usage during emergencies at all times in 2024 and 2025, especially during drills or real evacuations.
What is the purpose of this form?
This form serves as a vital tool for emergency responders and management at California State University, Dominguez Hills. Its primary purpose is to ensure the safety of all employees by accounting for them during evacuation procedures. By methodically documenting attendance, the form assists in safeguarding lives and facilitating proper emergency protocols.
Tell me about this form and its components and fields line-by-line.
- 1. Department: The department under which the employees operate.
- 2. Division: The division that oversees the department.
- 3. Location: The specific area or building where the evacuation is taking place.
- 4. Floor: The floor number of the location.
- 5. Date: The date of the evacuation.
- 6. Floor Warden Name: The name of the designated floor warden responsible for the area.
- 7. Employee Name: Space to list the names of employees present.
- 8. Present: Checkbox for employees who are present.
- 9. Missing: Checkbox for employees who are missing.
- 10. Not at Work: Checkbox for employees who are not at work.
- 11. Injured: Checkbox for employees who are injured.
- 12. Unresponsive: Checkbox for employees who are unresponsive.
What happens if I fail to submit this form?
Failure to submit this form can result in a lack of accountability during emergencies. This could complicate rescue efforts and put employees in danger as their whereabouts remain unknown. Proper submission is critical for the safety of all personnel involved.
- Employee Safety: Unaccounted employees can pose significant risks during crisis situations.
- Emergency Response Delays: Inaccurate attendance records can delay response times and efforts.
- Legal Compliance: Failure to document attendance may lead to violations of safety regulations.
How do I know when to use this form?
- 1. Fire Drills: Use this form during scheduled fire drills to practice evacuation procedures.
- 2. Real Emergencies: Employ whenever an actual evacuation is necessitated due to emergencies.
- 3. Safety Compliance Checks: Use periodically to ensure all personnel are informed about evacuation procedures.
Frequently Asked Questions
What is the purpose of this checklist?
The checklist is used to account for employees during an evacuation.
How do I edit this PDF?
You can edit the PDF directly by opening it in PrintFriendly and selecting the fields to modify.
Can I share the filled-out form?
Yes, after editing, you can easily share the PDF via email or a shareable link.
What information do I need to provide?
You need to provide the date, employee names, and their attendance status.
Is it necessary to use this form during an evacuation?
Yes, to ensure all personnel are accounted for.
How can I sign the PDF?
You can add your signature using the signing feature in the PDF editor.
Is there a limit to the number of employees I can list?
No, you can list as many employees as needed.
Can I print the checklist after editing?
Absolutely! You can print the edited PDF directly.
What should I do if an employee is missing?
Mark the respective box on the form and report it to authorities.
When should I fill out this form?
Fill it out during or immediately after an evacuation.
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