Fire Drill ReportFire Drill Report Please Fill out This Form: Facility Program * Supervisor * Date * Time * 121234567891011 : 0030 AMPMStaff Present: Name * Name First Name First Name Last Name Last Nameplus1 Add Staff minus1 Remove StaffResident Information: Name * Name First Name First Name Last Name Last Name Awake or Asleep * AwakeAsleep Time To Complete * Less than 2 minMore than 2 min Level of Support Needed * VerbalPhysicalTotal Care Exit Used * Refusal To Participate? * Yes No Explain The Situation * plus1 Add Resident minus1 Remove ResidentDevice Used To Sound Fire Alarm System? * Whistle Smoke Detector Alarm Other Identified Outdoor Meeting Location: * Supervisor Contact Date * Supervisor Name * Enter the name of the supervisor who reviewed the fire drill. Supervisor Signature * signature keyboard Clear Submit If you are human, leave this field blank.
