FIRE EMERGENCY & PREVENTION DRILL
(AFFILIATED WITH ACHIEVING BETTER COPING SKILLS, LLC)
R6-5-7464 (B,C,D
)
FACILITY ADDRESS (Select from Drop Down Menu)
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Please Select
366 W. 6th St, Mesa, AZ 85201 (Asher House)
2243 S. Evergreen Rd, Tempe, AZ 85282 (Shoulder
2427 E Menlo St., Mesa, AZ 85213 (Blake
Other
DATE OF FIRE DRILL
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Month
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Day
Year
Date
TIME OF DRILL (Include AM or PM)
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TOTAL EVACUATION TIME (Included Minutes and Seconds)
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SMOKE ALARMS CLEANED, TESTED AND BATTERIES REPLACED??
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YES
NO
CARBON MONOXIDE TESTED AND BATTERIES REPLACED?
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YES
NO
FIRE LOCATION
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EXITS USED DURING FIRE DRILL
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FRONT DOOR
BACK DOOR
SIDE DOOR
GARAGE DOOR
Other
PROBLEM NOTES
List the measures taken to ensure that children understand the purpose of a drill and their responsibilities during a drill.
DID EVERYONE PARTICIPATE?
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YES
Other
LIST ALL PARTICIPANTS (Separate with Commas)
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COMPLETED BY (STAFF NAME)
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Staff Signature
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Submit
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