Time Drill Begin:

Time Drill End:

Time Fire Dept. Notified:

Time Alarm Company Notified:

Engineer On-Duty:

Drill Conducted By:

Number of Smoke Compartments Observed:

Staff Procedures

Did Staff pull the fire alarm pullstation?

Did Staff know the emergency number to call? (SS-8911)(F-54321)(C-250)

Did Staff close room doors promptly?

Does Staff know the code for fire?

Did Staff bring fire extinguishers to the Code Red location?

Could Staff explain how to use a fire extinguisher or P-A-S-S?

Did Staff know the meaning of R-A-C-E?

Was Staff able to point out the location of the Medical Gas Zone valves?

Did Staff know who was authorized to shut off Medical Gas Zone valves?

Were evacuation corridors cleared of carts and other temporary obstructions?

Did Staff know where and how to move patients away from fire location?

Was Staff able to locate to locate their written fire evacuation/relocation plan and the evacuation diagram?

Was Staff able to locate Emergency Preparedness Manual and the Emergency Conditions Matrix?

Fire Team Response

Did PBX page Code Red and location clearly?

Did Fire Team respond promptly?

Did Fire Team respond with fire extinguishers?

Did Security Officer bring fire extinguisher?

Did Engineering know location of Medical Gas Zone valves?

Did Engineering know location of electrical panels?

Was the Fire Department notified by the alarm company?

Life Safety System

Did the pull station activate the Life Safety System?

Did all alarms and strobes function?

Could the overhead page for Code Red be heard?

Did all fire/smoke compartment doors automatically close?

Did the Life Safety system reset after alarm acknowledgement?


Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.