Muir Wood Quarterly Fire Drill Report
Name of Site
Please Select
Skillman North
Skillman South
Skillman East
Hannan Ranch
Thompson
Lohrman
Rebecca
Magnolia
Penngrove North
Penngrove South
Sonoma Mountain
Auberry North
Auberry South
Auberry West
Bradley
DiVinci
Mary
Petaluma IOP
Month of Drill
Please Select
January
February
March
April
May
June
September
October
November
December
Address of Site
Please Select
1733 Skillman Ln, Petaluma, CA 94952
1743 Skillman Ln, Petaluma, CA 94952
1336 Skillman Ln, Petaluma, CA 94952
621 Hannan Ranch Rd, Petaluma, CA 94952
900 Lohrman Ln, Petaluma, CA 94952
402 Rebecca St. Petaluma, CA 94952
2055 Magnolia Ln, Petaluma, CA 94952
501 Sonoma Mt. Rd. Petaluma, CA 94954
6868 Cold Springs Rd. Penngrove, CA 94951
6851 Cold Springs Rd. Penngrove, CA 94951
1830 Bradley St. Riverside, CA 92504
2225 Da Vinci St. Riverside, CA 92504
2320 Mary St. Riverside, CA 92504
18685 Auberry Rd. Clovis, CA 93619
12820 Auberry Rd. Clovis, CA 93619
32O Washington St. Petaluma, CA 94952
Name of Staff Conducting Fire Drill
Date of Drill
-
Month
-
Day
Year
Date
Time of Drill
Hour Minutes
AM
PM
AM/PM Option
Location of simulated fire
Please Select
Kitchen
Dining
Living Room
Office
Bedroom
Classroom
Group Room
Type of Fire
Please Select
Bed
Wastebasket
Kitchen Range
Laundry Room
Other
Extent of Fire
Please Select
Large
Small
Explosion
Electrical
Paper
Wood
Chemical
Controllable
Other
Extent of Smoke
Please Select
Noxious
Whole Room
Corridor
Heavy
Light
Smoldering
Other
Exit Used to Evacuate
Please Select
Front Door
Back Door
Side Door
Window
Other
Number of Clients
Names of Staff Members and Title Involved
Total amount of time from Alarm to Evacuation
Alarm System
Yes
No
Did staff use proper judgment?
Was the Fire Department called?
Were R.A.C.E protocols used?
Were clients moved to the evacuation site?
Halls, rooms and other means of egress were clear and free of obstruction?
Were all doors closed after rooms were evacuated?
Did staff monitor exits?
Did staff use fire equipment to extinguish fire?
The "all clear" was communicated to all persons involved?
Was the emergency plan executed properly?
Did staff carry out their responsibilities?
If "No" to any of the above, please provide an explanation.
Explanation to "No" checked above
Suggestions for Improvement
Staff Signature
Each site is required to conduct 1 monthly drill on each shift. One should be done for AM, Swing and Overnight. Records of drills are kept by the Chief Compliance Officer electronically.
Submit
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