Title Page
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Site investigated
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Unit / Department
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Prepared by Fire Safety Coordinator
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Date of the Incident
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Site Contact
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Emergency Officer / Coordinator
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Address
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Document number of Fire Alarm Investigation
Investigation of Code Red
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Start of Event
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End of Event
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Specific location of incident
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Level
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Zone
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Detector / MCP No.
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Cause of alarm activation
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Device activated
- Smoke Detector
- Heat Detector
- MCP
- Sprinkler
- Other
- No device activated.
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Provide details
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Who/What caused the alarm ?
- Technical Defect
- Employee
- Patient / Client
- Contractor
- Visitor
- Unknown
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Patient / Client details
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Contractor details
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Employee details
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Visitor Details
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Device type/description
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Were procedures followed ?
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What issues were identified ?
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Actions taken:
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Did personnel evacuate ?
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Health Security dispatched ?
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Security Incident Report
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Code Red Report
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RiskMan Report Number
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Images
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Additional documents
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Additional findings
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Recommendations / Actions Required
