Monthly Fire Drill Critique Form (Fire Area)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• REVIEWED BY FIRE SAFETY COMMITTEE ON _____________________

  Yes

  No

  N/A

• Date:

  Yes

  No

  N/A

• Building

  Yes

  No

  N/A

• Shift

  Yes

  No

  N/A

• Time. AM/PM

  Yes

  No

  N/A

• Reported by

  Yes

  No

  N/A

• Location observed

  Yes

  No

  N/A

ISSUE

• 1. Did the staff properly respond to initiate the alarm within 30 seconds?

  Yes

  No

  N/A

• 2. Was the overhead page announcement of the location heard?

  Yes

  No

  N/A

• 3. Was the alarm seen and heard in all areas?

  Yes

  No

  N/A

• 4. Was the back-up phone call made (simulated) to the fire department?

  Yes

  No

  N/A

• 5. Did the staff know the location of the fire extinguisher?

  Yes

  No

  N/A

• 6. Did a staff member (person in charge) provide adequate leadership in area?

  Yes

  No

  N/A

• 7. At least verbally (simulated) did the person in charge identify which patients need to be evacuated?

  Yes

  No

  N/A

• 8. Were all doors closed?

  Yes

  No

  N/A

• 9. Were patients in corridors placed into rooms?

  Yes

  No

  N/A

• 10. Was equipment cleared from the corridors?

  Yes

  No

  N/A

• 11. Did the fire/smoke doors close automatically?

  Yes

  No

  N/A

• 12. Were patients in rooms being checked by staff periodically?

  Yes

  No

  N/A

• 13. Did staff use proper judgement?

  Yes

  No

  N/A

• 14. Were exits monitored by staff? (psych only)

  Yes

  No

  N/A

• 15. Did staff responding to the scene do so immediately?

  Yes

  No

  N/A

• 16. Did staff responding to the scene understand their role upon arrival?

  Yes

  No

  N/A

• OBSERVATIONS: <br><br>

  Yes

  No

  N/A

• Resolution (name & date)

  Yes

  No

  N/A