Questionnaire on Emergency Evacuation Procedures

OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

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 that occurred on MONTH DAY, 2010.
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 to XXXXX

SECTION 1: Please answer the following questions about the time period between being
alerted (e.g., from the initial alarm) to the incident in this building and entering the
stairwell/elevator/exit.
(1) How did you first become alerted to the incident? Mark all that apply.
Alarm tone (e.g., slow whoop)
Voice alarm message to evacuate
Voice alarm message to wait on floor/remain on floor
Flashing strobe light
Manager of company/Boss
Floor warden for building
Colleague/coworker
Fire department personnel or equipment/trucks
Other, please specify ______________________________________________.
(2) Where were you when you first became alerted to the incident in this 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 _____________
(3a) On which floor were you located when you first became alerted to the incident? _______
(3b) What were you doing? ________________________________(e.g., working)
(4) What did you initially 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 ________________________________________________.

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OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

(5) After initial alert, did you receive any additional instructions/information from any of the
following while you were on that floor? If yes, number all that apply in the order that you
received them, beginning with (1). If necessary, you can number the same source of
information more than once.
_____Voice alarm message (What did the message say? _______________________)
_____Manager of company/Boss (What did he/she say? _______________________)
_____Floor warden (What did he/she say? _____)
_____A colleague/coworker (What did he/she say? _______________________)
_____Other, please specify _______________________________________________________.
(6) Please number the following actions from what you did first (1) after the first alert 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. If necessary, you can number the same action more than once.
_____Continued prior activity.
_____ Waited (for instructions , to see what others were doing , to see if anything else would
happen , other reasons to wait?________________________) (How long? ___ mins)
_____Looked around.
_____Sought more information about the event. (What information did you seek? _____________)
_____Gave instructions to others. (About what?________________________________________)
_____Discussed with others (inside the building , outside of the building ).
About what? _____________________________________________________________
_____Looked for others on the floor.
_____Gathered coat /shoes/valuables, dressed. (What things? __________________________)
_____Gathered emergency/floor warden supplies. (What things? __________________________)
_____Saved files/turned off computer/Secured files or documents.
_____Secured office/room/space (shut door , turned out light(s) , other? __________________).
_____Other, please specify _______________________________________________________.
_____Other, please specify _______________________________________________________.
(7a) Could you see others around you on your floor? Yes No
(7b) If yes,
How many?
1-2
3-5
6-10
11-20
21+
What were they doing? _______________________________________________.
(8a) Did you feel at risk (in danger) at any time before you entered the stairwell?
Yes – high level
Yes – moderate level
No
(8b) If yes, did your feeling of risk (in danger) increase before your entered the stairwell?
Yes
No
If yes, why?____________________________________________________________________.

(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.

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OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

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
Both Stair and Elevator
Walked directly outside to exit
I did not evacuate the building.
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 quicker.
Elevators are easier to use (physically).
Others were using the elevators
Elevators are my normal way of leaving the building.
I was instructed to use the elevator.
I could not find a stairwell.
Other ___________________________________.
(11c) How did you find the stairwell/elevator/exit that you used to evacuate from your floor?
I followed others/others were using this exit
I followed EXIT signs.
I knew the exit/I am familiar with the exit.
I used the closest 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 __ Stairwell __
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/other people 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 ___________________________________________________.
(12*a) During your evacuation, did you leave the stairwell for any reason other than exiting
the building or entering a transfer hallway?
Yes No
(12*b) If yes, on which floor(s) did this occur? ____________

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OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

(12*c) And, what caused you to leave the stairwell? Please mark all that apply.
Smelled smoke.
The stair was blocked (How? _____________________).
Crowding in the stairwell.
Thought another way would be quicker.
Instructed to do so
By Whom? ______________________________________
What were the instructions? _______________________
Followed other people.
Forgot something (What? ________________________).
Other _________________________
(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
(14a) From the time you entered the stairwell/elevator/exit until you left the building, how
many minutes passed? ________min.
(14b) What time was it when you exited the building? ________ (e.g., 10:30 am)
(15a) While in the stairwell/elevator, did you receive information or instructions that
influenced your behavior? Yes No;
(15b) If yes, number all that apply in the order that you received them, beginning with (1). If
necessary, you can number the same source of information more than once.
_____Voice alarm message (What did the message say? _______________________)
_____Manager of company/Boss (What did he/she say? _______________________)
_____Floor warden for building (What did he/she say? _____)
_____A colleague/coworker (What did he/she say? _______________________)
_____Other, please specify _______________________________________________________.
(16) When you exited the building, which exit did you use?
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 ____________________________________________________.

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OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

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? _____________________ (please provide a number)

(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
Evacuation drills/practice drills
Other, please specify ____________________________________________________.
(22b) How many fire drills have you participated in for this building in the last year?
None
1
2+
(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 Living with Partner
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) Are you a floor warden for this building? Yes
No
(24g) Are you a manager for your office/company? Yes
No

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OMB Control No. 0693-0051
Expiration Date: XX-XX-XXXX

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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