Fire Drill Assessment

• AnMed Health Fire Drill

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Healthcare

Fire Drill Assessment

• 1. Did participants of the fire drill demonstrate knowledge of the use and function of the fire alarm system?

  Yes

  No

  N/A

• 2. Did staff members know the location of the nearest pull station?

  Yes

  No

  N/A

• 3. Did staff know that extension ???? is the number to call in order to report a fire within the facility?

  Yes

  No

  N/A

• 4. Was ???? dialed during this drill?

  Yes

  No

  N/A

• 5. If ???? was dialed, did the staff member identify their self and area?

  Yes

  No

  N/A

• 6.Did the staff member give the exact location of the fire?

  Yes

  No

  N/A

• 7. Did the staff member describe the nature and extent of the fire?

  Yes

  No

  N/A

• 8. Did the participants demonstrate the knowledge of confining the fire?

  Yes

  No

  N/A

• 9. Were the doors in the fire drill area closed?

  Yes

  No

  N/A

• 10. Did the staff know the location of the nearest fire extinguisher within the drill site area?

  Yes

  No

  N/A

• 11. Did the participants demonstrate knowledge of the PASS procedure for using a fire extinguisher?

  Yes

  No

  N/A

• 12. Did the participants demonstrate knowledge of the RACE procedure?

  Yes

  No

  N/A

• 13. Did the participants understand what each of their specific responsibilities are during a fire?

  Yes

  No

  N/A

• 14. Could the participants point out the location of the O2 shut-off valve?

  Yes

  No

  N/A

• 15. Could the staff explain the procedures they would implement if ordered to evacuate the area? Indicating the difference between vertical and horizontal evacuation?

  Yes

  No

  N/A

• 16. Did staff members of adjacent areas, including areas above and below the drill site; demonstrate knowledge of the fire drill announcement? If so, list the personnel surveyed including their respective areas.

  Yes

  No

  N/A

• 17. Were the visual and audible alarms noticeable in the fire drill area as well as in adjacent areas?

  Yes

  No

  N/A

• 18. Were additional fire extinguishers brought to the drill site? If so, how many and by whom?

  Yes

  No

  N/A

• 19. Was the "All Clear" announcement given in a clear and easily understood manner by the switchboard operator.

  Yes

  No

  N/A

• 20. Were the doors in the fire drill area closed?

  Yes

  No

  N/A

Scoring:

• Enter any additional comments that you feel are relevant to this particular drill.

• Please enter your name then sign when assessment is completed.

  Sign

• Yes

  No

  N/A