Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Site Information

  • Shift

  • Quarter

Drill Assessment

  • 1. Did participant of the fire drill zone staff demonstrate knowledge of the use and function of the fire alarm systm?

  • 2. How to pull the nearest fire alarm?

  • 3. Do staff know the appropriate # to dial to report a fire for your facility?

  • 4. Was this # dialed?

  • 5. Identified self and area?

  • 6. Gave exact location of fire?

  • 7. Described nature and extent of fire?

  • 8. Did the participant demonstrate the knowledge of confining the area of fire?

  • 9. Closing Doors?

  • 10. Knew the location of the nearest fire extinguisher?

  • 11. Knew the PASS procedure of a fire extinguisher?

  • 12. Knew the RACE procedure?

  • 13. Knew the specific fire responsibility to their area?

  • 14. Knew the location of the O2 shut-off valve?

  • 15. Knew the procedure to prepare for evacuation?

  • 16. Did the staff of the adjacent, above, below or other areas demonstrate the knowledge of the fire drill annoucement?

  • 17. Did the staff demonstrate knowledge of how to transfer to area of refuge?

  • 18. Did the staff know the horizontal / vertical evacuation sequence?

  • 19. Did the staff know how to reach an "Area of Refuge"?

Scoring:

  • Enter any comments along with score " Passed or Failed "

  • Please enter your name then sign when assessment is completed.

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