• Document No.

  • Department

  • Conducted on

  • Conducted by


  • Was manual pull station activated by employee

  • Did fire alarm chimes sound/strobes flash

  • Was phone call made to PBX by dialing 555

  • Was audible page made by PBX operator

  • Time monitoring service received alarm


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

  • We're doors closed, hallways cleared

  • Time the fire brigade arrived

  • Overall effectiveness:

  • Was all clear announced by PBX

  • Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.