• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Location of the Drill or Code Red

  • This was :


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

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

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

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

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

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

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

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

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

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

  • Comments

  • Participants at the Scene

  • Staff
  • Sign

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.