FIRE EMERGENCY & PREVENTION DRILL
(AFFILIATED WITH BEHAVIORAL COUNSELING SERVICES, LLC)
R6-5-7464 (B,C,D
)
FACILITY ADDRESS (Select from Drop Down Menu)
*
Please Select
366 W. 6th St, Mesa, AZ 85201 (Asher House)
603 N. Vista Del Sol, Mesa, AZ 85207 (Moses House)
2243 S. Evergreen Rd, Tempe, AZ 85282 (Shoulders)
2427 E Menlo St., Mesa, AZ 85213 (Blake
1317 N. Rochester, Mesa, AZ 85205 (Lincoln House)
Other
DATE OF FIRE DRILL
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-
Month
-
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?
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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
*
Submit
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