• Select date

  • Department

  • Other Departments Observed

  • Adjacent -

  • Above -

  • Below -

  • Who conducted the drill?


  • Did staff rescue those in immediate danger?

  • Did staff alerts others in/around the fire area?

  • Was the 911 called?

  • Did staff activate the fire alarm system?

  • Did staff close patient room & corridor doors?

  • Were corridors free of obstructions for evacuation?

  • Did staff keep calm and guide patients and visitors?

  • Did someone take charge of the situation?

  • Were fire extinguishers deployed?

  • Did non-area staff respond timely to assist?


  • Did someone take charge of the situation?

  • Were all doors closed in corridor?

  • Were corridors cleared of obstructions?

  • Were patients and visitors kept in rooms?

  • Were patients and visitors kept informed?


  • Are staff familiar with RACE?<br>Race Activate Contain Evacuate

  • Are staff familiar with PASS?<br>Pull the pin Aim. Aim the nozzle. Squeeze the handle. Sweep from side to side.

  • Do staff know the location of the nearest fire alarm pull station?

  • Do staff know the location of the departments portable fire extinguishers?

  • Do staff know the medical gas shutoff valve location and who is authorized to shut down piped gasses to the unit?

  • Do staff know the adjacent smoke compartment?


  • Was the alarm audible throughout the area?

  • Was the alarm visible throughout the area?

  • Did all fire system features work appropriately? Magnetic door holds released, heat, smoke, and strobes all function, and no obvious sprinkler system concerns in area?


  • Do staff know the department evacuation plan?

  • Do staff know the appropriate evacuation destination for their patients?

  • Do staff know the evacuation routes / emergency egress routes from their department?

  • Do staff know the difference between horizontal and vertical evacuation?

  • Are staff familiar with appropriate evacuation methods for their patient population?

  • Is evacuation equipment available and appropriate for patient population?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.