Post Oak ER - Fire and Safety Drill

• Location:
  Address

• Conducted on:

  Date

• Prepared by:

  Shelley White

• Prepared by Title

  Administrator

  Safety Officer

  Manager

• On site representative

• On site representative Title

• All staff participating in drill (Name and Title)

Pre Drill Assesment

• Evacuation Routes Posted

  Yes

  No

  N/A

• Exit clearly marked and Illuminated

  Yes

  No

  N/A

• Exit doors unlocked from the inside

  Yes

  No

  N/A

• Fire Department Present for Drill

  Yes

  No

  N/A

Communication

• Alarm monitoring company notified Prior to Drill

  Yes

  No

  N/A

• Method of Alarm Activation

  Pull Station

  Smoke Alarm

• Fire alarm clearly heard in all areas

  Yes

  No

  N/A

• Strobe Alarm Visible

  Yes

  No

  N/A

• Alarm Monitoring Company Received Signal

  Yes

  No

  N/A

Fire Containment (RACE | PASS)

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

  Yes

  No

  N/A

• Employees understands RACE

  Yes

  No

  N/A

• Employee understands PASS

  Yes

  No

  N/A

• Fire extinguisher taken to location of fire

  Yes

  No

  N/A

Utilities

• Electrical appliances we turned off

  Yes

  No

  N/A

• Lights were turned off

  Yes

  No

  N/A

• HVAC units were shut down

  Yes

  No

  N/A

Plan

• Evacuation performed according to plan

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Drill/Response Team acted according to plan

  Yes

  No

  N/A

Evacuation

• Restrooms checked for occupants

  Yes

  No

  N/A

• Evacuation was orderly

  Yes

  No

  N/A

• Visitors escorted and accounted for

  Yes

  No

  N/A

• Special needs persons accommodated

  Yes

  No

  N/A

• Overall response of occupants

  Compliant

  Non-Compliant

  N/A

Post Fire Drill Evaluation

• Was staff effective in evacuating the building

  Yes

  No

  N/A

• Is the evacuation plan written adequately

  Yes

  No

  N/A

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

  Pass

  Fail

  N/A

• Does all staff know the safe meeting place

  Pass

  Fail

  N/A

Record Keeping

• Special conditions simulated (Patient Requiring Oxygen)

  Yes

  No

  N/A

• Problems encountered

• Date of Last Fire Drill

• Date of Last Yearly Fire Evaluation

• Type of Fire Extinguisher

  ABC

• Size of Fire Extinguishers

  2.5

  5

  10