Run Shift-Specific Fire Drill Documentation — Free

Drill Identification

Drill date and time recorded critical (required)

Shift identified critical (required)

Drill scenario documented critical (required)

Areas or units included in the drill

Drill conducted on a shift not previously covered this year critical (required)

Yes No N/A

Alarm and Emergency Response

Fire alarm or drill notification activated critical (required)

Yes No N/A

Staff acknowledged alarm promptly critical (required)

Yes No N/A

Emergency communication completed per facility procedure

Yes No N/A

Staff assigned roles and responsibilities during the drill

Yes No N/A

Resident Safety and Evacuation Performance

Residents were protected in place or moved per plan critical (required)

Yes No N/A

Smoke doors, compartment doors, and exits remained unobstructed critical (required)

Yes No N/A

Resident headcount or accountability completed critical (required)

Yes No N/A

Evacuation or relocation time recorded

Note (optional)

Staff Performance and Equipment Readiness

Staff demonstrated knowledge of RACE/PASS or facility fire response procedure critical (required)

Yes No N/A

Portable fire extinguishers accessible and inspection current critical (required)

Yes No N/A

Exit routes and fire doors were clear and functional critical (required)

Yes No N/A

PPE or emergency equipment used appropriately if applicable

Yes No N/A

Deficiencies, Corrective Actions, and Sign-Off

Deficiencies identified

Note (optional)

Corrective action documented for any deficiency

Supervisor or designee signature critical (required)

Inspector comments

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Run: Shift-Specific Fire Drill Documentation

Drill Identification

Alarm and Emergency Response

Resident Safety and Evacuation Performance

Staff Performance and Equipment Readiness

Deficiencies, Corrective Actions, and Sign-Off

Get your results