Evaluation of Hospital Disaster Drills: Figure 1: Sample Page from an Evaluation Module

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Evaluation of Hospital Disaster Drills: A Module-Based Approach

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Figure 1: Sample Page from an Evaluation Module

Question		Response
C11. Did someone take charge of this zone?		Y / N / U
C12. If someone took charge of this zone, how many minutes after the drill activities in this zone began did this person take charge? (Check one)		O < 10 min
		O 10-29 min
		O 30-59 min
		O 1-2 hrs
		O > 2 hrs
		O NA
C13. If someone took charge of this zone, was it the officially designated person?		Y / N / U / NA
C14. How was the person in charge of the zone identified? (Check all that apply)		a. [ ] Arm band b. [ ] Hat c. [ ] Name tag d. [ ] Verbal statement e. [ ] Vest f. [ ] Not identified g. [ ] Other physical identification (specify): ______________________________________
C15. Were the following drill participants identifiable?	a. Drill evaluators	Y / N / U / NA
	b. Drill organizers	Y / N / U / NA
	c. Media	Y / N / U / NA
	d. Medical personnel	Y / N / U / NA
	e. Mock victims	Y / N / U / NA
	f. Observers	Y / N / U / NA
	g. Security	Y / N / U / NA

Question	Response
IC1. Who first took charge of this zone? (name and title)	______________________________________ ______________________________________
IC2. How many minutes after the drill activities in this zone began did the officially designated incident commander arrive? (Check one)	O < 10 min
	O 10-29 min
	O 30-59 min
	O 1-2 hrs
	O > 2 hrs
	O Never arrived
IC3. Were other members of the incident command center easily identifiable?	Y / N / U

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