Fire Drill
To be completed monthly following required drill at each provider location.
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Month *
Date Drill Completed *
MM
/
DD
/
YYYY
Provider First Name *
Provider Last Name *
Informed? *
How was the individual informed about the drill?
Required
Time Drill Began *
Time
:
Time Drill Ended *
Time
:
Members that participated *
Smoke Detectors? *
Smoke detectors checked on each floor and are operational.
Carbon Monoxide? *
Carbon monoxide detector checked and operational?
Issues? *
Were there issues? Please indicate what & describe plan of action here.
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