Muir Wood Quarterly Fire Drill Report
Name of Site
Month of Drill
Address of Site
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
Name of Staff Conducting Fire Drill
Date of Drill
Time of Drill
Location of simulated fire
Type of Fire
Extent of Fire
Extent of Smoke
Exit Used to Evacuate
Number of Clients
Names of Staff Members and Title Involved
Total amount of time from Alarm to Evacuation
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
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.
Should be Empty: