• Hospital building, floor, unit:

  • Nurse Manager, Email, Person interviewed:

  • Conducted on

  • Conducted by Barbara Back<br>Occupational Safety Compliance Officer<br><br>Office: 804-827-0345<br>Cell: 804-400-4979

Unit Drilled

  • 1) Means of egress were properly maintained on the unit? (No unattended storage, storage not blocking safety equipment)?

  • 2) Could staff locate their "Unit Specific Emergency Preparedness Plan"?

  • 3) Could staff identify the information the Unit Specific Plan contains such as number of patients, relocation/evacuation areas and transportation needs?

  • 4) Could staff identify the primary and secondary exit routes - the closest and most appropriate exits?

  • 5) Could staff locate a fire extinguisher?

  • 6) Did staff know how to use the fire extinguisher?

  • 7) Did staff know the location of Oxygen/Medical gas shutoff valves and which rooms the valves control

  • 8) Did staff know who is authorized to cut off the medical gas shut-off valves?

  • 9) Did staff know if there are adequate portable oxygen tanks available in the event of an oxygen failure?

  • 10) Did staff know to call *500 for fire emergencies?

  • 11) Did staff readily know location of pull station to activate the alarm after dialing *500?

  • 12) Did staff ensure safety of all patients and visitors (close doors, cleared corridors, assisted with evacuation or in defend-in-place buildings - ensure they were in rooms and off unit)?

  • *Note type of staff observed

Score and recommendations

  • Very Good - 100 Good 90-99 Fair 75- 89 Poor - 74 or below (requires a re-drill to be performed within 30 days) Please review the following recommendations with your staff.

  • Your area did not perform well and a re-drill is required with in next 30 days. <br><br>Please take time to review procedures with your staff and contact me with any questions.

Observed areas (units on floor not drilled, two floors above the alarm and one below)

  • 1) Means of egress were properly maintained on the unit? (No unattended storage, storage not blocking safety equipment)?

  • 2) Was the storage cleared during the alarm?

  • 3) Was "Unit Specific Emergency Preparedness Plan" posted?

  • 4) Did Hospital Personnel close doors during alarm?

  • 5) Did Hospital Personnel assist/notify patients and visitors?

Fire alarm system

  • Did the fire alarm devices work properly (fire doors, horns & strobes)?

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