Information

  • Conducted on

  • Shift:

  • Time lapse before response:

  • Location:

  • Type of incident:

  • Was the drill announced or unannounced?

  • Individuals associated with the incident / drill:

  • Prepared by

  • Did responding parties demonstrate organization and appropriate response?

  • We're patients, visitors and others removed from the scene?

  • Was the alarm activated or simulated?

  • Was it reported to the hospital operator for overhead paging (or simulated)?

  • Was it reported to off site responders (or simulated)?

  • Did the alarm sound in all areas?

  • Was the enunciator panel located?

  • Were the doors closed appropriately?

  • Did the fire smoke doors close appropriately?

  • Were the halls and exits cleared of obstructions and equipment?

  • Was a fire extinguisher brought to the point of fire?

  • Was the proper use of the fire extinguisher demonstrated (or simulated)?

  • Was the evacuation plan reviewed and routes identified?

  • Was an alternate smoke compartment for horizontal evacuation identified?

  • Was the oxygen shutoff valve identified and staff knowledgeable about responsibility to shut off?

  • We're patients and visitors reassured (or simulated)?

  • Analysis of drill response:

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