Monthly Fire Drill Log Report

Monthly Fire Drill Log Report

Please utilize the below report form to complete and submit your monthly Fire Drill Log. Fire Drill Logs should be submitted by 12noon on the 10th of each month. If the 10th happens to fall on a weekend or holiday, your Fire Drill Log should be submitted the following business day, no exceptions.

Provider Name*

Select

Program Name*

Select

Program Site Address*

Contract Number*

Date of Fire Drill Completion*

Please enter the time in which the fire drill started.*

Please utilize the below format when entering the time in which the fire drill started:

Example: 8:00am or 8:00pm

Please enter the time in which the fire drill ended.*

Please utilize the below format when entering the time in which the fire drill ended:

Example: 8:00am or 8:00pm

Please enter the shift in which the fire drill was completed.*

Please refrain from entering "Shift 1 or Shift 2". Instead, please utilize the below format:

Example: 8:00am-4:00pm or 4:00pm-12:00am, or 12:00am-8:00am.

Please enter the name/title of the individual conducting the fire drill*

Please utilize the below format:

Example: Sarah Johson, Shift Supervisor

Please indicate how the fire drill was initiated.*

Please specify how the fire drill started.

Example: A staff member manually triggered the alarm.

Was DC FEMS contacted prior to the drill?*

Select

Please describe the weather at the time of fire drill completion.*

Examples: Cloudy, sunny, raining, snow

Please indicate the total number of children that evacuated.*

For the purpose of this form, "children" should be classified as persons aged 17 and younger.

Please indicate the total number of adults that evacuated.*

For the purpose of this form, "adults" should be classified as persons aged 18 and older.

Please indicate the total number of individuals with disabilities that required assistance with evacuating.*

Example: An individual with a wheelchair or walker

Please indicate the total number of individuals that evacuated.*

This number should include the total number of children, adults and individuals with disabilities.

Was the fire drill alarm reset following completion of the fire drill?*

Select

Was the sprinkler system restored following completion of the fire drill?*

Select

Please enter the names and titles of all staff that participated in the fire drill.*

Please utilize the below format:

Example:

Sherry Palmer, Case Manager
Tim Davis, Residential Advisor
Keisha Matthews, Residential Advisor

Please enter the name and title of the individual submitting this report.*

*By entering your name below, you are certifying that all information entered in this report is accurate/correct to the best of your knowledge. By entering your name below, you are also confirming that you understand that entering false information into this report can result in disciplinary measures taken by TCP.

Date of Submission*

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