TJC - Tracer - Staff Interviews

• Department
  Address

• Conducted on

  Date

• Prepared by:

• Location:
  Address

• Personnel

Staff Verbalize Knowledge of...

• Dr. Red (Fire)

  Yes

  No

  N/A

• Code Blue (Medical Emergency)

  Yes

  No

  N/A

• Code Tango (Tornado)

  Yes

  No

  N/A

• Code Green (External Disaster)

  Yes

  No

  N/A

• Code Echo (Internal Disaster)

  Yes

  No

  N/A

• Code Pink (Missing Child)

  Yes

  No

  N/A

• Active Shooter

  Yes

  No

  N/A

• R.A.C.E

  Yes

  No

  N/A

• Emergency-dial 222

  Yes

  No

  N/A

• P.A.S.S

  Yes

  No

  N/A

• Can staff locate the Emergency Operations Plan (on-line or hard copy)

  Yes

  No

  N/A

• Staff can explain job role/tasks for external emergencies

  Yes

  No

  N/A

• Staff can explain evacuation procedure

  Yes

  No

  N/A

• Who is the Safety Officer?

  Yes

  No

  N/A

• What do you do in a Dr. Red situation?

  Yes

  No

  N/A

• What is the procedure for using a fire extinguisher?

  Yes

  No

  N/A

• Where is the nearest fire extinguisher?

  Yes

  No

  N/A

• Where is the nearest fire pull station?

  Yes

  No

  N/A

• Staff know how to report defective medical equipment

  Yes

  No

  N/A

• Staff know how to report defective utility (non-medical) equipment

  Yes

  No

  N/A

• Staff know how to report overfull sharps containers

  Yes

  No

  N/A

• Staff know how to access policies and procedures

  Yes

  No

  N/A

• Staff know how to access SDS and understand how to use them

  Yes

  No

  N/A

• Staff know how to report a chemical spill

  Yes

  No

  N/A

• Staff know how to report a security emergency

  Yes

  No

  N/A

• Staff know how to report a safety concern

  Yes

  No

  N/A