Fire Drill Report

The Fire Drill Report –

Date – current/day of the fire drill

Client Name – full legal name of the consumer

Home Name – will the name of the home, usually the assigned code name

Address – the address of the group home in which the fire drill was conducted

Internal – means inside of the facility/home

External – means the outside of the facility/home

Manual – manual alarm notification such as your voice or bell

Detector – smoke detector notification. You typically push the tester button on the smoke detector

“Other” – upper management could enter the home and conduct a fire drill or a phone call

Drill wake – usually during the day (before bedtime)

Drill asleep – usually during the night while the consumers are sleeping

Time Began – start time, upon notification rather it be ‘manual’

Time End – end time, after/within the 3 minutes (required time)

EXAMPLES: 1:00pm – 1:03pm/6:23am – 6:26pm/2:59pm – 6:02pm, no more than 3 minutes

Number of Staff – all of the staff on duty

Number of Residents – residents in the home at the time of the fire drill

Location of Simulated Fire – where the fire started such as ‘in the trashcan’

Escape Route Used – primary in the front door

Alternate Escape Route Used – if primary route is not used the alternate route can/may be used this can be window, the back door, a side door from the garage

Staff and Residents were evacuated to – this should be the assigned designated location list on the evaluation plan. Questions taken from the required Fire Drill Form used by some Provider/Companies

Questions:

Did any residents require assistance? – refer to the evacuation plan that is individualized for the consumer. Staff will learn if the consumer is non ambulatory or ambulatory. Assistance can also mean the consumer going into shock and not thinking on their feet, it could mean behavior issues arising, and it could mean the consumer could have injured themselves during this process.

Did any residents resist leaving the facility? – refuse to leave rather it be behavior or fear.

Did any resident fail to follow instructions? – as in going the opposite directions.

Did the primary escape route remain open? – this answer should also be answered yes. In the event of a real fire and the fire starts at or near the front door then staff and consumer may not be allowed to exit the primary route.

Was the evacuation plan followed? – this question should always be answered yes, refer to the individualized EVACUATION PLAN for each consumer. (required)

Was a head count on residents and staff? – the answer should always be yes.

Were fire extinguishers obtained? Always know the location of the fire extinguishers in the home in which you are assigned to work.

Comments - this section is used to comment such as hospitalization, injury, resistance, defective smoke detector.

The Staff Supervisor/Staff Conducting the fire drill should sign and document their job title.

Other staff in the home should sign the fire drill report as well.

In most companies, the original copy of the fire drill should be turned in the office and a copy should be filed in each of the consumer’s Field/Information Book.



Fire Drill Form, HHS Texas

Form Birds, a free printable fire drill form



Your Provider/Company may have their own form.

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