Fire Drill Initiation and Procedures

1. Inform fire company of fire drill to have them turn emergency personnel alert system offline.

2. Pull fire alarm or set off detector. 3. Administrator/DON/Charge Nurse depending on shift goes to fire

system panel box to locate where fire alarm is tripped. Locate tenant roster, visitor log, and tenant sign out sheets for tenant/visitor roll call after full evacuation.

4. Charge person lets staff know where fire is located via walkie talkie/verbal cues/all page, depending on facility.

5. All staff on duty will go to area of fire, Charge person grabbing the closest fire extinguisher to the fire location. (If actual fire occurs, attempt to extinguish using P.A.S.S. method with extinguisher if possible without putting self in danger).

6. All staff will help evacuate the closest residents to the fire location without putting themselves in danger and assist tenants if needed to the closest exit away from fire location. Place evacuated sign on door handle once room is searched/cleared of residents if applicable. If no signs, place pillow/blanket/rug to indicate room has been evacuated.

7. Continue evacuating closest residents to fire until building is fully evacuated. Checking all room in facility including Med Room/ Offices/ Laundry/ Kitchen/ Break Rooms/ Public Restrooms/ Beauty Shop/ Maintenance/ Housekeeping.

8. Once outside meet all residents and staff to pre-determined safe area away well from building and parking lot so emergency vehicles may enter.

9. Take roll call and wait for all clear from maintenance staff conducting fire drill. Maintenance will silence and reset fire panel

10. Call fire company to report all clear and get back online. 11. Properly document that fire drill was completed including staff

signatures and resident roster.

Issued: 5/2017 www.PetersenHealthCare.net

Tornado/Earth Quake Drill

A. Date of tornado/earth quake: _______________________ B. Alarm sounded? Yes ______ No ______ C. Time? _____________________ D. Was this a planned monthly drill? Yes ______ No ______ E. Shifts 6-2 ___________ 2-10 ______________ 10-6 _________________ F. Employee responsible for drill ___________________________________

Signature Position Signature Position _________________ _________________ _______________________ ____________

_________________ _________________ _______________________ ____________

_________________ _________________ _______________________ ____________

_________________ _________________ _______________________ ____________

_________________ _________________ _______________________ ____________

_________________ _________________ _______________________ ____________

G. Reaction of personnel in drill area.

a) Knew evacuation procedure & route? Yes ______ No ______ b) Did personnel respond appropriately? Yes ______ No ______ c) Moved ambulatory residents to the lounge? Yes ______ No ______ d) Bedfast residents moved away from window? Yes ______ No ______ e) Staff helped residents to take care? Yes ______ No ______ f) Fire department responded? Yes ______ No ______ g) Evacuation necessary? Yes ______ No ______ h) Nurse knows where the main gas and electric shut off valves are? Yes ______ No ______ i) Nurse knows to check all injured before moving? Yes ______ No ______ j) Staff knows the difference between watch and warning? Yes ______ No ______

Person completing this Form: ________________________________________________ Administrator’s Signature: __________________________________________________ Facility: _________________________________________________________________