East Central Regional Hospital Fire Drill

• Drill Scenario:

• Was drill an evacuated or non-evacuated drill?

  Select Evacuated Non-evacuated

  • Evacuated
  • Non-evacuated

• Shift?

  1st

  2nd

  3rd

• Campus

  Gracewood

  Augusta Campus

• Time of alarm? (Military time)

• Building

• Was fire alarm activated?

  Yes

  No

  N/A

• Conducted on

  Date

• Prepared by:

Headcount

• Number of staff in the building/unit at time of alarm?
  

• Number of individuals in the building/unit at time of alarm?

• Number of visitors in the building/unit at time of alarm?

Response to Fire Alarm - Staff Response

• R: Rescue. Staff removed anyone in immediate danger. Clients were located through one smoke/fire barrier?

  Yes

  No

• A: Alarm. Activated the nearest alarm and called Emergency number GW 2211/AC 7034. Proper announcement over the Radio.

  Yes

  No

• Did staff announce a Code Red?

  Yes

  No

  N/A

• C: Confine. Staff closed the door to the room of fire origin and other client room doors.

  Yes

  No

• E: Extinguish Did staff demonstrate the use of a fire extinguisher or evacuate building?<br>

  Yes

  No

• Were corridors and egress routes clear?

  Yes

  No

• Did all automatic fire, magnetically locked and smoke doors close or latch?

  Yes

  No

  N/A

Evacuation

• Did everyone assemble in designated evacuation area?<br><br>evacuated drill - 200 ft away from building or in fenced courtyard<br>non-evacuated drill - at the exit door to the evacuation location

  Yes

  No

• Did staff grab a fire extinguisher?

  Yes

  No

• Did staff grab a radio?

  Yes

  No

  N/A

• Was alarms visible and audible?

  Yes

  No

  N/A

• Did all staff and individuals evacuate the building in the proper time?

  Good (<3 mins.)

  Fair (3 -13 mins.)

  Poor (>13 mins.)

• Time all staff/individuals were out of building

  Date

Demonstration of Staff Knowledge

• Staff demonstrated knowledge, skills to implement the Code Red?

  Yes

  No

• Does staff demonstrate how to announce a "Code Red" using the radio?

  Yes

  No

• Did staff know the location of the fire extinguishers in their unit?

  Yes

  No

• Did staff know the location of the fire alarm pull stations in their unit?

  Yes

  No

  N/A

• Does staff know where the emergency manual "rainbow book" is located in their unit?

  Yes

  No

• Did staff understand the meaning of R.A.C.E.?<br><br>R - Rescue<br>A - Alarm<br>C - Contain<br>E - Extinguish / Evacuate

  Yes

  No

• Did staff understand the meaning of P.A.S.S.?<br><br>P - Pull the Pin<br>A - Aim at the base of the fire<br>S - Squeeze the handle<br>S - Sweep from side to side

  Yes

  No

• All staff have ID badges and fire keys?

  Yes

  No

All clear

• Time "all clear" is given?

  Date

• Was this a successful drill?<br><br>must have a grade of 90% or higher to pass drill.

  Yes

  No

• Evaluation of staffs response to this drill or actual fire incident