Emergency Drill Record Form

Emergency Drill Record

Needs to be completed Monthly
Service Type*

Adult ServicesChildren's ServicesSupported Living
Location: *
Adult Service Location*
If any location is missing or needs deleted please contact Risk Management
Children's Service Location*
If any location is missing or needs deleted please contact Risk Management
Supported Living Location*
If any location is missing or needs deleted please contact Risk Management
Event Type*
Type a question*

Monthly DrillAnnual DrillActual Occurance
Date*

MonthDayYear
Date
Time Drill Performed *

Hour Minutes

AM/PM Option
How long the drill took to complete:*
Minutes:Seconds
Number of Evacuees*
Equipment checked for Drills only
Fire Extinguishers
AED Battery and Pads
Additional Comments
Note:

School: Fire drills are to be conducted at least once each month, this includes elementary; intermediate grade levels; and secondary level. School administration staff will coordinate monthly drills and submit the Emergency Drill Record to Lakemary Center’s risk management department.

PRTF Residential. Fire drills are to be conducted at least once each month, on each shift, for every residential housing unit. Supervisory staff or designee will conduct the monthly drills and submit the Emergency Drill Record to the risk management department.
Leadership Review

Fill in each area
Areas needing Improvement*
Actions to be Taken*
Necessary Education and Training of Personnel:*
Actions Completed and Did it accomplish intended results? *
First and Last Name
Name

First NameLast Name
Should be Empty:

Emergency Drill Record

Equipment checked for Drills only

Leadership Review