Fire Drill Critique

• Who conducted the drill?

• Date of Drill:

• Date Fire Drill Evaluation Completed:

• PLEASE FILL OUT SEPARATE FORM FOR ANY ADDRESSES FOUND TO BE AT RISK. ALL ADDRESSES FOUND TO BE SAFE CAN REMAIN ON ONE FORM

• Which addresses is this evaluation for?

FIRE AREA RESPONSE CRITIQUE

• Did staff rescue those in immediate danger?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Was the 911 called?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Did staff close patient room & corridor doors?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Were corridors free of obstructions for evacuation?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Did staff keep calm and guide patients and visitors?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Did someone take charge of the situation?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Were fire extinguishers deployed?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Did non-area staff respond timely to assist?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Did someone take charge of the situation?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Were patients and visitors kept informed?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

STAFF KNOWLEDGE

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

FIRE SYSTEM CRITIQUE

• Was the alarm audible throughout the area?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• Was the alarm visible throughout the area?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

• 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?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

EVACUATION CRITIQUE

• Do staff know the department evacuation plan?

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4

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

  Safe

  At Risk 1

  At Risk 2

  At Risk 3

  At Risk 4