Fire Drill Log Form PDF Details

Ensuring the safety of patients, visitors, and staff in healthcare facilities is paramount, which is why conducting regular fire drills is essential. The Fire Drill Log form, used by Wright State Physicians, offers a systematic approach to evaluating these drills, ensuring every aspect of the emergency response is scrutinized for efficacy and compliance. This comprehensive form is divided into several key sections, including Immediate Staff Response, Staff Knowledge, and Fire Alarm Equipment Performance, each aimed at assessing different facets of the drill. Through questions concerning whether staff closed all fire doors, cleared fire exit corridors, informed individuals of the alarm condition, and responded correctly to the fire's point of origin, the Immediate Staff Response section evaluates the promptness and accuracy of actions taken during the initial phase of the drill. The Staff Knowledge section focuses on understanding and applying emergency procedures like R.A.C.E. (Rescue, Alarm, Contain, Evacuate) and P.A.S.S. (Pull, Aim, Squeeze, Sweep), alongside the familiarity with fire alarm pull stations, fire extinguishers, fire exits, smoke compartments, and evacuation procedures. Lastly, the Fire Alarm Equipment Performance section assesses the functionality of critical systems and hardware, such as the audibility of the "CODE RED" alert, the proper closing and latching of automatic fire doors, and the working condition of fire alarm devices. Accompanied by a Fire Drill In-service & Attendance Sign In Sheet, this form not only serves as a tool for evaluation but also as a vital record for compliance and improvement. Implemented first on May 1, 2007, with subsequent revisions, it underscores a consistent effort towards enhancing fire safety protocols, making it a cornerstone document for any safety-conscious healthcare facility.

QuestionAnswer
Form NameFire Drill Log Form
Form Length2 pages
Fillable?Yes
Fillable fields97
Avg. time to fill out19 min 54 sec
Other namesdoor log sheets, printable fire drill log sheet, fire drill log form, door sheets form

Form Preview Example

WRIGHT STATE PHYSICIANS

Fire Drill Evaluation Form Date of Fire Drill ________________________________ Location of Drill ______________________

Section 1 – Immediate Staff Response

 

Competently Performed

 

 

 

 

 

 

 

 

Did staff close all fire doors in the area, including patient exam room doors?

 

Y

N

Were the fire exit corridors cleared of unnecessary equipment?

 

Y

N

Did Staff inform Patients/Visitors of Alarm Condition?

 

Y

N

Did unit send a responder to the fires Point of origin?

 

Y

N

 

 

 

 

 

Section 2 – Staff Knowledge

 

 

Competently Performed

 

 

 

 

 

 

 

Did Staff identify and apply R.A.C.E. (Rescue, Alarm, Contain, Evaculate)

 

 

Y

N

Did Staff identify and apply P.A.S.S. (Pull, Aim, Squeeze, Sweep)

 

 

Y

N

Did staff know the location of Fire Alarm Pull Stations in their work area?

 

 

Y

N

Does staff know the location of fire extinguishers in their work area?

 

 

Y

N

Did staff know where the fire exits were in the drill area?

 

 

Y

N

Did the staff know where the smoke compartments were in the observation area?

 

 

Y

N

Did staff know the evacuation procedure?

 

 

Y

N

 

 

 

 

 

 

 

Section 3 – Fire Alarm Equipment Performance

 

 

Equipment

 

 

 

 

Functioned properly

 

 

 

 

 

 

 

 

 

 

 

 

 

Was the “CODE RED” alert audible in the area being evaluated?

 

 

Y

N

Did all Automatic fire doors close & latch?

 

 

Y

N

Were fire alarm devices functioning properly in area observed?

 

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fire Drill In-service & Attendance Sign In Sheet

Name

Name

Name

Wright State Physicians R2007

Completed by and date:_______________________________________________

Implementation Date: May 1, 2007

 

Revision Date:

 

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