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Parkview Noble Hospital

CODE RED DRILL REPORT FORM

Complete this form for each fire drill performed. Note observations and any issues for corrective action.
Associated Event   
* Location of Drill Performed
* Date:
  Time Fire Drill Started
  Time Fire Drill Ended
PRE-DRILL
Contact City of Kendallville (260-347-0654) and advise that we are conducting a drill.
CODE RED DRILL INFORMATION:
* Drill Performed
Select the Quarter when Fire Drill was performed
1st Quarter     2nd Quarter     3rd Quarter     4th Quarter    
* Time Period for Fire Drill 6AM to 4PM
4PM to 10PM
10PM to 6AM
* Type of Fire Drill Alarm Audible     Silent     Actual Alarm    
HOSPITAL STAFF KNOWLEDGE:
* RACE & PASS YES     NO    
  Location of nearest Fire alarm pull stations YES     NO    
* Location of nearest Fire extinguishers YES     NO    
  Location of Emergency Exits & Evacuation routes YES     NO    
HOSPITAL COMMUNICATIONS:
* Voice Service Operator called
1911
YES     NO     N/A    
* “All Clear” announced & "All Clear" sent to Pager/Text Group YES     NO     N/A    
LIFE SAFETY SYSTEMS:
  All corridor facing doors were closed YES     NO     N/A    
* Exit signs illuminated YES     NO    
* Strobes & Alarms working YES     NO     N/A    
* CODE RED DRILL Evaluation: (3) All drill/plan/system elements performed appropriately – no corrective actions needed
(2) Some drill/plan/system elements need improvement and/or corrective actions
(1) All drill/plan/system elements did not perform appropriately – immediate corrective actions
* CODE RED DRILL Evaluation: Comments
* Person conducting the Fire Drill: