Republic of the Philippines Department of Educaon-Region III Division of San Jose City San Jose City Naonal High School
EARTHQUAKE DRILL EVALUATION FORM Date/Time: Place of Drill: School Name: Location in the school during the drill: Name of Evaluator: The evaluator works in the Barangay ffice: !ES
Signature: N"
#ls$ s#ecify
%$ Encircle the letter of your choice$ &$ 's the siren siren loud loud enough enough to (e (e heard (y (y all the the drill drill #artici#an #artici#ants) ts) a$ !ES ($ N If NO, please elaborate: elaborate: *$ Did the drill #artici#ants #artici#ants #ractice #ractice the +Duck" +Duck" ,over and and -old. techniue during during the %larm Phase 0while the siren is (eing sounded1) a$ !ES ($ N If NO, please elaborate: elaborate: 2$ During During the the %larm Phase" Phase" what what did the #arti #artici#an ci#ants ts do) do) a$ The #artic #artici#an i#ants ts evacua evacuate te while while the (ell is ringin ringing$ g$ ($ The #artici#ants waited waited for the siren to sto# (efore (efore evacuating$ c$ thers" thers" #lease #lease ela(orate ela(orate 33333333 333333333333 33333333 333333333 333333333 33333333 333333333 33333333$ 333$ 4$ Did the drill drill #artici #artici#ant #antss follow follow their design designated ated routes routes to evacuati evacuation on area) a$ !ES ($ N If NO, please elaborate: elaborate: 5$ 6hat did did the #artici#an #artici#ants ts do during during the evacuation evacuation #hase) #hase) a$ The The #art #artic ici# i#an ants ts run$ run$ ($ The #artici#ants walk walk casually$ casually$ c$ The #art #artici ici#an #ants ts walk walk faste fasterr than than norma normal$ l$ 7$ Did the drill #artici#ants #artici#ants (ring any first aid kit or any item noticea(le during the the evacuation #hase) a$ !ES ($ N If NO, please elaborate: elaborate: 8$ Did the drill drill #artici #artici#ant #antss conduct conduct the headcoun headcountt during the the headcoun headcountt #hase) #hase) a$ !ES ($ N If NO, please elaborate: elaborate: 9$ 's the evacuatio evacuation n area (ig (ig enough enough to accommodat accommodatee the evacue evacuees) es) a$ !ES ($ N If NO, please elaborate: elaborate: $ 6hat did did the #artic #artici#ant i#antss do while while they are in the the evacuation evacuation area) a$ The #art #artici ici#an #ants ts stay stay in the the evacua evacuatio tion n area$ area$ ($ The #artici#ants move move to other #lace$ c$ The #artici #artici#ant #antss go (ack (ack to the the (uilding (uilding without without instruc instruction tion$$ B$ Please write down your o(servations in the s#ace #rovided$ &$ %ny other other #ro(lem #ro(lem o(served o(served during during the drill drill that that might might need to (e address addressed) ed) Please ela(orate: -ow long did it take for all the drill #artici#ants to vacate the (uilding and time to reach the designated evacuation area) "! (served Num(er of Partici#ants 0estimates will do1: !
PARTICIPANTS
NO. OF LEARNERS
COUNT
,$ 'f you have suggestions" #lease write them down in the s#ace (elow$
*This form is based from Evaluation Form A in DepEd Order No. 4, s. !"#!
