Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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Time of drill (24 hr)
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Yes. No. N/A
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Was alarm initiated immediately?
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- yes
- no
- N/A
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Did area staff respond immediately to their procedure?
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- yes
- no
- N/A
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Did staff throughout the facility respond to procedure?
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- yes
- no
- N/A
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Did security respond to the area?
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- yes
- no
- N/A
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Were area protective systems in place?
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- yes
- no
- N/A
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We're all exits manned?
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- yes
- no
- N/A
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Did hospital operator announce proper overhead page?
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- yes
- no
- N/A
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Were all staff, patients, visitors required to stay in area?
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- yes
- no
- N/A
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Were all staff, patients and visitors stopped from entering area?
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- yes
- no
- N/A
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Was child, infant abduction/ missing adult successfully detained?
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- yes
- no
- N/A
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Did elevators lock out operation?
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- yes
- no
- N/A
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Was drill performed in conjunction with fire alarm activation?
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- yes
- no
- N/A
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Additional comments?
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Add signature
