Enhancing the earthquake behavioral responses and post-earthquake evacuation preparedness of building occupants is beneficial to increasing their chances of survival and reducing casualties after the mainshock of an earthquake. Traditionally, training approaches such as seminars, posters, videos or drills are applied to enhance preparedness. However, they are not highly engaging and have limited sensory capabilities to mimic life-threatening scenarios for the purpose of training potential participants. Immersive Virtual Reality (IVR) and Serious Games (SG) as innovative digital technologies can be used to create training tools to overcome these limitations. In this study, we propose an IVR SG-based training system to improve earthquake behavioral responses and post-earthquake evacuation preparedness. Auckland City Hospital was chosen as a case study to test our IVR SG training system. A set of training objectives based on best evacuation practice has been identified and embedded into several training scenarios of the IVR SG. Hospital staff (healthcare and administrative professionals) and visitors were recruited as participants to be exposed to these training scenarios. Participants’ preparedness has been measured along two dimensions: 1) Knowledge about best evacuation practice; 2) Self-efficacy in dealing with earthquake emergencies. Assessment results showed that there was a significant knowledge and self-efficacy increase after the training. In addition, participants acknowledged that it was easy, helpful, and engaging to learn best evacuation practice knowledge through the IVR SG training system.