GSH Quarterly Fire drill

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Location/ Zone of the drill.

• Yes

  No

  N/A

Shift drill was preformed on.

• Yes

  No

  N/A

Did the alarm company receive a signal?

• Yes

  No

  N/A

888-684-2684 Acct # A14664413

General questions

• Can staff explain what RACE stands for?

  Yes

  No

  N/A

• Can staff explain what PASS stands for?

  Yes

  No

  N/A

• Can staff explain where the closest pull station is?

  Yes

  No

  N/A

• Can staff explain where the closest fire extinguisher is?

  Yes

  No

  N/A

• Did the fire doors operate properly?

  Yes

  No

  N/A

• Did the staff close the patient doors?

  Yes

  No

  N/A

Persons responding to the drill.

• Yes

  No

  N/A

Total number of persons responding to the drill.

• Yes

  No

  N/A

Number of Extinguishers brought

• Safe

  At Risk

  N/A

Person doing drill.

• Jason Sartain

  Sign