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Fire Drill Report Form13.doc - pdfMachine from …

Fire Drill Report Facility Name:_____. Address:_____. Date: _____ Time: _____ Shift: _____. (24 Hour Clock). Person conducting the Drill : _____. (Name & Title). Fire Alarm Activation Method: _____. (Between 9:00 and 6:00 : A coded announcement can be used instead of audible alarms). Drill location and simulated conditions:_____. _____. (Bedridden patients shall not be required to be moved during Drill MSFC ). Unusual Conditions:_____. (weather , remodeling, temporary exits). Number of occupants evacuated: _____ Total Time of Drill : _____. Fire alarm system reset?: _____ Sprinkler System restored?:_____. Critique:_____. _____. Fire alarm system tested:_____ Verified by:_____. Monitoring company received signal at:_____ Verified by:_____. (24 hour clock). List all staff members on duty and participating: _____ _____ _____.

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Transcription of Fire Drill Report Form13.doc - pdfMachine from …

1 Fire Drill Report Facility Name:_____. Address:_____. Date: _____ Time: _____ Shift: _____. (24 Hour Clock). Person conducting the Drill : _____. (Name & Title). Fire Alarm Activation Method: _____. (Between 9:00 and 6:00 : A coded announcement can be used instead of audible alarms). Drill location and simulated conditions:_____. _____. (Bedridden patients shall not be required to be moved during Drill MSFC ). Unusual Conditions:_____. (weather , remodeling, temporary exits). Number of occupants evacuated: _____ Total Time of Drill : _____. Fire alarm system reset?: _____ Sprinkler System restored?:_____. Critique:_____. _____. Fire alarm system tested:_____ Verified by:_____. Monitoring company received signal at:_____ Verified by:_____. (24 hour clock). List all staff members on duty and participating: _____ _____ _____.

2 _____ _____ _____. _____ _____ _____. _____ _____ _____. _____ _____ _____. _____ _____ _____. _____ _____ _____.


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