Questionnaire on Emergency Evacuation Procedures

OMB Control No. 0693-XXXX

Expiration Date: XX-XX-2011

Questionnaire on Emergency Evacuation Procedures

Purpose

This survey is being conducted by the National Institute of Standards and Technology (NIST), an agency of the U.S. Department of Commerce, in order to improve the emergency procedures of this building. We ask that you complete this survey about your participation in the evacuation drill conducted on _________ (date).

Completing this questionnaire is voluntary, but your assistance would be greatly appreciated to help improve the safety of the building occupants.

Please return this questionnaire using the provided self-addressed, stamped envelope.

SECTION 1: Please answer the following questions about the time period between being alerted (e.g., from the alarm) to the incident in this building and entering the stairwell/elevator/exit.

1. Where were you when you first became alerted (e.g., from an alarm) to the incident in this building? (To be tailored to rooms in involved building)

 Your own office/room  Restroom  Cafeteria  Stairwell

 Colleague’s office/room  Elevator  Basement  Storage / copy area

 Meeting room  Corridor  First floor lobby  Other, specify _____________

(2a) On which floor were you located when you first became alerted to the incident? _______

(2b) What were you doing? ________________________________(e.g., working, watching TV)

(3) How did you become alerted to the incident? Mark all that apply.

 Alarm tone

 Voice alarm message to evacuate

 Flashing strobe light

 Member of building staff (management or fire safety)

 Evacuation coordinator/fire warden

 Colleague/resident

 Other, please specify ______________________________________________.

(4) What did you think was going on?

 Real fire emergency

 False alarm (the alarm is sounding by mistake)

 Test of equipment

 Regularly scheduled fire drill

 Security situation

 Weather emergency

 I didn’t know what was going on

 Other, please specify __­­­_____­­­­­_________________________________________.

(5) Once you were alerted to the incident, did you receive any instructions on where to go or what to do from one of the following? If yes, mark all that apply.

 Voice alarm message

 A member of building staff (management or fire safety)

 A colleague/resident

 An evacuation coordinator/fire warden

 Other, please specify _______________________________________________________.

(6) Please number the following actions from what you did first (1) to what you did next (2), and continue to number all of the actions that you performed until you entered the stairwell/exit. Please number the following actions (only those that apply) on the lines provided

_____Continued prior activity.

_____Waited (for instructions , to see what others were doing , to see if anything else

would happen ).

_____Looked around.

_____Investigated – looked for the source of the alarm. (Where did you go? _________________)

_____Sought more information about the alarm/alert.

_____Followed instructions. From whom? _______________________________

_____Gave instructions to others on what to do.

_____Discussed with others (inside the building , outside of the building ).

About what? _____________________________________________________________

_____Looked for others in the building.

_____Gathered coat / shoes, dressed. (What things? __________________________________)

_____Gathered valuables. (What things? ____________________________________________)

_____Gathered emergency/coordinator supplies. (What things? __________________________)

_____Saved file/turned off computer.

_____Secured files/documents.

_____Secured office/room/space (shut door , turned out light(s) , other? __________________).

_____Moved to a stairwell/elevator/exit (Started evacuation).

_____Other, please specify _______________________________________________________.

_____Other, please specify _______________________________________________________.

(7a) Could you see others around you on the floor?  Yes  No

(7b) If yes,

How many?  1-2  3-5  6-10  11-20  21+

What were they doing? _______________________________________________.

(8) Did you feel at risk (in danger) at any time before you entered the stairwell?

 Yes – high level  Yes – moderate level  No

(9) What was the main thing/reason that made you decide to evacuate?

_______________________________________________________________________.

(10) How much time passed from the moment that you became alerted to the incident until you entered the stairwell/elevator/exit? __________min.

SECTION 2: Please answer the following questions about the time period between entering the stairwell/elevator/exit and leaving the building.

(11a) How did you evacuate the building?

 Stairwell  Elevator  Walked directly outside to exit

 Other, please specify _____________________________________________________.

(11b) If you used an elevator, what was your primary reason for not using a stairwell?

 I have a condition that requires me to use an elevator.
 Elevators are more convenient.
 I could not find a stairwell.  Other ___________________________________.

(11c) How did you find the stairwell/elevator/exit that you used to evacuate?
 I followed others.

 I followed EXIT signs.

 I knew the exit.
 I used the way I came in.

 I was instructed to use this exit.

 Other, please specify ______________________________________________________.

(12) If you left by a stairwell,

(a) Did you use…  Stairwell __  Stairwell __ [Designations, e.g., A, 1, north, blue, to be

tailored to involved stairwell]

(b) Please check any of the conditions you encountered during the evacuation:

• Furniture or other object(s) obstructed entry to stairwell.

• Crowding in the stairwell.

• Difficulty opening stairwell or exit doors (Which doors? _________________________).

• Uncomfortable handrails.

• Poor lighting.

• Emergency responders were coming up stairwell.

• People in front of you were moving too slowly.

• People were standing /resting on the landings.

• Confusion with which way to proceed.

• Shoes were uncomfortable for the required distance.

• Other, please specify ___________________________________________________.

(13a) During your evacuation, could you see others around you (e.g., in the stairwell)?

 Yes  No

(13b) If yes, were they the same people from your floor?

 Yes  No

(14) From the time you entered the stairwell/elevator/exit until you left the building, how many minutes passed? ________min.

(15a) Did you receive information or instructions that influenced your behavior while in the stairwell/elevator? Yes  No;

(15b) If Yes, where did it come from (mark all that apply):

 Voice (public announcement) system in the building

 Member of building staff (management or fire safety)

 Another evacuee

 Manager of your company (if a business occupancy)

 Other, please specify __________________________________________________________.

(15c) If Yes, what was this information? ____________________________________________.

(16) When you exited the building, which exit did you use? [Designations, e.g., A, 1, north, blue, to be tailored to involved building]

 Exit ___  Exit ___

 Exit ___  Exit ___

 Other, please specify _____________________________________________________.

(17) Did any of the following conditions make your evacuation more difficult?

• Temporary injury/condition, please specify ___________________________________.

• Medical condition

• Respiratory condition

• Cardiovascular condition

• Chronic condition

• Other, please specify ________________________________________________.

• Vision impairment

• Hearing impairment

• Overweight

• Mobility impairment/disability

• Pregnancy

• Other, please specify ____________________________________________________.

SECTION 3: Please provide background information about you and your experience with building evacuations.

(18) Have you ever been in a building fire before (where you saw smoke or flames and/or you felt at risk)?

 No

 Yes, in this building

 Yes, in another building

(19) What year did you begin living/working in this building? _________or  N/A (e.g., visitor).

(20) How many times do you remember the fire alarm sounding in this building in the last year?

 None

 1 or 2 times

 3 to 5 times

 6+ times

(21) Have you received any form of fire emergency training for this building?

 No

 Yes, but not in the past 12 months.

 Yes, in the past 12 months.

(22a) If yes, how did you receive the fire emergency training (check all that apply):

 Pamphlets or guides

 Video

 Seminars or presentations

 Other, please specify ____________________________________________________.

(22b) How many fire drills have you participated in for this building in the last year?

 None

 1 or 2

 3+

(23a) Are you aware of the fire evacuation procedure for this building?  Yes  No

(23b) If yes, please describe:

___________________________________________________________________________.

(24a) Sex:  M  F

(24b) How old are you?  18-25  26-35  36-45  46-55  56-65  66+

(24c) Current status:  Currently married  Widowed  Divorced  Separated  Never married

(24d) Do you have any children (under 18)?  Yes  No

(24e) Highest level of education:  Some high school  High school graduate  Some college  College degree  Advanced degree

(24f) What is your native language?  English  Spanish  Other, please specify __________.

(24g) Are you an evacuation coordinator/fire warden for this building?  Yes  No

Any Additional Comments:

Thank you for taking the time to help us improve
emergency procedures and safety!

NOTE: This questionnaire contains collection of information requirements subject to the Paperwork Reduction Act (PRA). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to penalty for failure to comply with, a collection of information subject to the requirements of the PRA, unless that collection of information displays a currently valid OMB Control Number.  The estimated response time for this questionnaire is 10 minutes.  The response time includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this estimate or any other aspects of this collection of information, including suggestions for reducing the length of this questionnaire, to the National Institute of Standards and Technology, Attn., Erica Kuligowski, erica.kuligowski@nist.gov, 301-975-2309.  

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