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Methodist Hospital

Fire Drill/Alarm Activation Evaluation

For Associated Event: Please select "No Event Selected" from the drop down box below.
Associated Event   
* Location of Drill/Alarm
  Specific Location of Drill/Alarm
  Time and Date of Drill/Alarm
  Name of Surveyor
  Was the PA announcement clear and audible in the corridors? YES     NO     N/A    
  Audible alarm was heard from each work station throughout department. YES     NO    
  Did the automatic fire doors operate properly? YES     NO     N/A    
  Were passageways free of obstacles? YES     NO     N/A    
  Did staff close all doors & openings? YES     NO     N/A    
  Did staff follow all procedures and report back to their workstations? YES     NO     N/A    
  Staff is familiar with the term RACE as used in hospital setting? YES     NO     N/A    
  Staff is able to locate the nearest fire extinguisher? YES     NO     N/A    
  Staff is able to locate the nearest fire alarm pull station? YES     NO     N/A    
  Staff is able to describe the procedure for using a fire extinguisher (PASS)? YES     NO     N/A    
  Staff is able to describe Code Red as used in hospital policy? YES     NO     N/A    
  Comments: