Oklahoma Heart Fire Drill or Code Red Evaluation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Location of the Drill or Code Red

• This was :

  Scheduled Drill

  False Alarm

  Actual Code Red

Observations

• Did the staff know procedures for initiating a Code Red?

  Yes

  No

  N/A

• Did staff alert coworkers of drill/fire and were instructions provided to activate "RACE" proceedures?

  Yes

  No

  N/A

• Did staff call PBX and give name and location of drill/fire

  Yes

  No

  N/A

• Did staff know the location of the nearest fire alarm pull in their area?

  Yes

  No

  N/A

• Did staff know the location of the nearest fire extinguisher in the area?

  Yes

  No

  N/A

• Did the staff communicate drill/fire process with patients and visitors in the area?

  Yes

  No

  N/A

• Did the staff confine the area by closing all doors?

  Yes

  No

  N/A

• Was the staff familiar with medical gas valve locations and shutoff procedures?

  Yes

  No

  N/A

• Was "All Clear" determined by responders, and was PBX notified?

  Yes

  No

  N/A

• Did staff communicate "All Clear" procedures to coworkers, patients, and visitors in the area?

  Yes

  No

  N/A

• Comments

• Participants at the Scene

Staff

• Sign

  Sign