NORTH FULTON HOSPITAL

• Document No.

• Department

• Conducted on

  Date

• Conducted by

  Mac Nelson

  Larry Collett

ALARM NOTIFICATION

• Was manual pull station activated by employee

  Yes

  No

  N/A

• Did fire alarm chimes sound/strobes flash

  Yes

  No

  N/A

• Was phone call made to PBX by dialing 555

  Yes

  No

  N/A

• Was audible page made by PBX operator

  Yes

  No

  N/A

• Time monitoring service received alarm

  Date

STAFF RESPONSE

• We're patient, visitors, and staff removed from danger

  Yes

  No

  N/A

• We're doors closed, hallways cleared

  Yes

  No

  N/A

• Time the fire brigade arrived

  Date

• Overall effectiveness:

  Select Quick Adequate Inadequate Improvements Needed

  • Quick
  • Adequate
  • Inadequate
  • Improvements Needed

• Was all clear announced by PBX

  Yes

  No

  N/A

• Comments