Title Page
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Site conducted
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Conducted on
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Evacuation total time:
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Safety representative in charge of drill
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Location
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Shift
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Number of Clients Involved
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Number of Staff Involved
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Was the drill
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Alarm was heard throughout the site?
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All doors were closed?
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Patients, visitors and staff proceeded to the closet exists?
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Roll call was performed at the designated safe area?
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All hallways leading to the exits were clear?
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Were fire extinguishers at site in all the specific locations around the building?
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Did patients, visitors and staff proceed to the designated safe area?
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If actual fire was 911 called?
- Yes
- No, small containable fire, 911 unnecessary
- N/A this was only a drill
- No did not call in time for help
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Staff followed the policy and procedure? Out within 2 minutes?
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Which staff were present?
- April Strong
- Cassidy Ferguson
- Christine Weeks
- Cindy Riordan
- Dahana Emile
- Doreen Clancy
- Dr. Jacqueline Boutrouille
- Elizabeth Giglio
- Erin Sherman
- Farah Geffrard
- Joan Morris
- Kathy Maenza
- Michelle Wichter
- Kristen Sanabria
- Lisa McWhorter
- Dr. Marc Schlosser
- Mary Joseph
- Michelle Fyfe
- Portia Mitsifer
- Priscilla Berardo
- Sarah Mehan
- Stephanie Confalone
- Tammie Sellman
- Mariann Senor
- Amber Moreland
- Victoria Maurice
- Valerie Jordan
- Kaneeshia Studstill
- Chrisanna Thompson
- Caitlyn Lemson
- Alexandra Pachter
- Alisa Williams
- Amy Millin
- Bridget Nazar
- Coral Agard
- Cynthia Salley
- Dana Barczewski
- Heather Silversmith
- Isabelle Clairvoyant
- Quae Bentley
- Jessyca Anderson
- Julie Spiros
- Junette Gedeome
- Kayla Rodgers
- Kendra Williams
- Marie Louis
- Maryann Elberth
- Michelle Yates
- Nicole Condurso
- Patricia Gulides
- Paula Broughton
- Peyton Davis
- Rebekah Augustin
- Tiesha Mack
- Zakiya Edwards
- Rhonda Fitzshall
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Observations/Unusual Occurrences:
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Strengths and Weaknesses:
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Recommendations/Corrective Actions:
