FIRE DRILL & TESTING FORM Manor

SUPERIOR MANOR FIRE DRILL INSTRUCTIONS

ACCOUNT # 17080173

1. CALL 314-381-4500 & SELECT OPTION 2

2. ASK TO GO OFFLINE FOR 15-20 MINUTES

3. GO TO A PULL STATION & UNSCREW FROM WALL TO EXPOSE THE SWITCH

4. FLIP THE SWITCH, FIRE ALARM WILL START

5. MEET RESIDENTS ACROSS THE STREET ON CLINTON

6. DO AN ATTENDANCE CHECK

7. GO BACK TO PULL STATION & FLIP SWITCH BACK TO NORMAL

8. AFTER DRILL IS COMPLETE, PRESS 1,2,3,4, ENTER. THEN 1,2,3,4, ACK. THEN 1,2,3,4, SILENCE. THEN 1,2,3,4, RESET

9. THE ALARM WILL RESET & LIGHTS WILL STOP FLASHING

10. CALL 314-381-4500, PRESS OPTION 2 & ASK IF THEY HAVE RECEIVED THE SIGNAL. ASK FOR THE REPRESENTATIVE'S NAME & ASK TO BE PLACED BACK ONLINE.

11. DOCUMENT ANY PROBLEMS OR CONCERNS AND THE PERSON AT THE ALARM COMPANY YOU SPOKE TO.

IF YOU HAVE ANY ISSUES DURING OR AFTER THE DRILL, CALL THE ALARM SPECIALIST BACK & ASK FOR DUANE. HE WILL WALK YOU THROUGH ANY ISSUES NOTIFY ADMINISTRATION STAFF OF DRILL RESULTS

FIRE DRILLS ARE MANDATORY. ANY REFUSAL TO CONDUCT A FIRE DRILL WILL RESULT IN TERMINATION

FIRE:

In case of fire:

1. Remove the residents from the immediate danger are to the nearest safe area.
2. Close the door of the room as you leave. A must if fire is this room.
3. Notify the fire department (by direct alarm or telephone).
4. Calmly notify another employee in the home of the danger-preferably the supervisor.
5. Attempt to extinguish the fire with the proper firefighting equipment.
6. All employees proceed to fire stations and begin your pre-assigned duties, such as closing fire and smoke doors, windows, removing additional residents adjacent to the danger are, shut off mechanical equipment, etc.

EVACUATION INSTRUCTIONS:

1. Residents near fire or smoke must be removed first.
2. Remove ambulatory residents first, then wheel chair residents (if complete and mass evacuation is necessary).
3. Primary concern and your first responsibility is always the resident.
4. A responsible person must remain with the evacuated residents to prevent re-entrance to the home.
5. Have pre arrangements made to some designated area separate from the facility to house residents during the emergency period,(E.g. Buttons & Bows).

DateTime

Shift

DESCRIPTION OF THE DRILL:

RESULT OF THE DRILL:

ANY PROBLEMS IDENTIFIED DURING THE DRILL:

Name(s) of Staff Participating:

Name(s) of Resident not Present:

Last Drill Completed By:

Shift

Current Census:

Head Count:

- out of building in less than 3 attempts:

YES NO

Harold Nathaniel

Length of Evacuation time:

Length of Drill:

Fire Equipment Tested by:

Did you contact Alarm Services and ask if they received the signal?

YES NO

I spoke to (Name at Alarm Services):

Do Drills Between:

8AM-4PM 4PM-12MN 12MN-8AM

Approved Rejected

Director/Administrator's Signature:

Clear