Title Page

  • Location:
  • Conducted on:

  • Prepared by:

  • Prepared by Title

  • On site representative

  • On site representative Title

  • All staff participating in drill (Name and Title)

Pre Drill Assesment

  • Evacuation Routes Posted

  • Exit clearly marked and Illuminated

  • Exit doors unlocked from the inside

  • Fire Department Present for Drill

Communication

  • Alarm monitoring company notified Prior to Drill

  • Method of Alarm Activation

  • Fire alarm clearly heard in all areas

  • Strobe Alarm Visible

  • Alarm Monitoring Company Received Signal

Fire Containment (RACE | PASS)

  • Did staff appropriately respond to alarm (Close all doors | Retrieve All fire extinguishers)

  • Employees understands RACE

  • Employee understands PASS

  • Fire extinguisher taken to location of fire

Utilities

  • Electrical appliances we turned off

  • Lights were turned off

  • HVAC units were shut down

Plan

  • Evacuation performed according to plan

  • Meeting place at safe distance from building A and B (Red Marked Lines)

  • Occupants met at designated place per plan A (South Parking)

  • Occupants met at designated place per plan B (West Parking)

  • Drill/Response Team acted according to plan

Evacuation

  • Restrooms checked for occupants

  • Evacuation was orderly

  • Visitors escorted and accounted for

  • Special needs persons accommodated

  • Overall response of occupants

Post Fire Drill Evaluation

  • Was staff effective in evacuating the building

  • Is the evacuation plan written adequately

  • Evaluate the occupants ability to provide assistance to visitors or individuals who are experiencing difficulty

  • Does all staff know the safe meeting place

Record Keeping

  • Special conditions simulated (Patient Requiring Oxygen)

  • Problems encountered

  • Date of Last Fire Drill

  • Date of Last Yearly Fire Evaluation

  • Type of Fire Extinguisher

  • Size of Fire Extinguishers

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