Shift-Specific Fire Drill Documentation

Inspection template for documenting fire drills in a nursing home by shift, including scenario, timing, staff response, evacuation performance, and corrective actions to support annual drill coverage across all shifts.

Drill Identification

• Drill date and time recorded
• Shift identified
• Drill scenario documented
• Areas or units included in the drill
• Drill conducted on a shift not previously covered this year

Alarm and Emergency Response

• Fire alarm or drill notification activated
• Staff acknowledged alarm promptly
• Emergency communication completed per facility procedure
• Staff assigned roles and responsibilities during the drill

Resident Safety and Evacuation Performance

• Residents were protected in place or moved per plan
• Smoke doors, compartment doors, and exits remained unobstructed
• Resident headcount or accountability completed
• Evacuation or relocation time recorded

Staff Performance and Equipment Readiness

• Staff demonstrated knowledge of RACE/PASS or facility fire response procedure
• Portable fire extinguishers accessible and inspection current
• Exit routes and fire doors were clear and functional
• PPE or emergency equipment used appropriately if applicable

Deficiencies, Corrective Actions, and Sign-Off

• Deficiencies identified
• Corrective action documented for any deficiency
• Supervisor or designee signature
• Inspector comments