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HomeMy WebLinkAboutFAI21-0013 CF Fire Drills i; irchard HOSPITAL FIRE DRILL EVALUATION DATE //z3/21 DEPARTMENT - �l SCORE 1-10-di(.1 'foilo(or Dr,'1�n PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) tDaVF ALARM ACTIVATION(PULL STATION PULLED, 1-10) - / v DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) to PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) l0 FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) It, CORRIDORS(ALL ITEMS ON ONE SIDE,1-10) l0 RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) ( b OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) l� OBERSERVERS: MANAGER: TOTAL K1 . V crk S SCORE (0.100) /C�j 1rchard HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT J l;rc_ e•]f DATE //z.j /Z.I DEPARTMENTS) ATTENDEES: 156et A "v Ili/ken Sc r lie2. A la • APP 3.S Y(Ol MfiA `w- 4. Cif MI 13,971-616-P1 5. iIa bb_ J r +► 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ATTENDANCE RECORD 01082016 MW 4Jrchard HOSPITAL FIRE DRILL EVALUATION DATE 2I 26I2 DEPARTMENT � SCORE PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) ALARM ACTIVATION (PULL STATION PULLED,1-10) 1c� DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) to EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) /O PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) CORRIDORS(ALL ITEMS ON ONE SIDE, 1-10) IO RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) 1D OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) Y `os- o r tdrk J Arte-f ri1914r (,(o!k� 1H 9O(, bt,"rrcA _ ty)CA }/1-cK,A_ U9cV OBERSERVERS: Ill MANAGER: TOTAL - SCORE (D-LOO} *rch and , HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT Tile (i),'LSI DATE 9 J 2 6/2I DEPARTMENT(S) /Ltii< ( ,o, ATTENDEES: 1' ecr+cellZ L'i rare - 2 ,Sityjs 1VI 54. fes _ I a. k,R :_ s. 53XCAVI lk thOir 8re--je---- 6. v ' e 4 7. tt-t\4 (C 1Z L th)7 . 8.Pr► a,..._._ ' . Pt') Civ Ii 26/2 9. ti ' 1 GirGS • r 'VI) /V .P6 9-C 11. 12 Ch10472 i ' ' Mac/ _ 260 Zeit \-\\(\‘- ,4 , kW 0 cQ-k- 1-911 -al JA- 13.E 41.6c/v-r& +�o,ik 1,„ d 5 il., ), . 9_ ( - 14. 15. 16. 17. 18. 19. 20. ATTENDANCE RECORD 01082016 MW 4Jrchard HOSPITAL Youlrri Our Priorly ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: 2/2b/21 Shift: 7-3 )c 3-11 11-7 Fire Location: /1/;,rsc 5A Observation Location: ll,.rfr At. �., Time Employee found Fire Site: 10 13 Time Announced on PA System: o)3 Time Alarm Activated: ►O I t-1 Time Drill completed /0? ' Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates theC C- ��� action to be taken or at a fire. •Pr _ \ar _ Define RACE. 2. The acronym PASS indicates how 1 `-Os'4V`\ S- to fight the fire with an extinguisher, Define PASS. P^ `I" - s q) 3. What is the hospital code for fire CiDDE and how is It reported? u\X.e lou.i s424 '2)7 4. Staff knew the location of fire hvSS2i 5. ,n alarms. _ 5. Staff knew the location of the fire2 €X�i�k 5 ►� extinguishers. -o.::c -6k-r row 6. Staff knew evacuation route, fire rnekp vs:n6QA GocV- exits, & location of emergency V egress directory. 7. Staff closed all doors and windows. 8. Automatic Fire Doors closed. ✓ 9. Patient evacuation list prepared. V 10. Fire chimes were heard by staff. _ 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and / how to operate. Comments: Action taken: Observer Signature: 'L0. 4Jrchard HOSPITAL You're Our Priorky ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: 2/2.L_/./ Shift: 7-3 (X 3-11 11-7 Fire Location! ItJ,,isr )1,.,1-0," Observation Location: "Lis..rsr ALA.-9n Tim°e'Employee found Fire Site: / o 13 Time Announced on PA System:_ /oj3 Time Alarm Activated: j = r ! Time Drill completed /02.6 Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the i SC,tAX,) fN arm, action to be taken or at a fire. CO rl k1n1 e-vacotait Define RACE. 2. The acronym PASS indicates how J Pt.t i� i A; (fl) to fight the fire with an S'qu• tZ-C Swims extinguisher. Define PASS. 3. What is the hospital code for fire ✓ C o d e. veCt and how is it reported? 4. Staff knew the location of fire ✓ alarms. 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. 13. Automatic Fire Doors closed. ✓/ 9. Patient evacuation list prepared. ✓ _ 10. Fire chimes were heard by staff. �/ 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and how to operate. Comments: Action taken: Observer Signature: Name : C s or(5 chard HOSPITA -` FIRE DRILL EVALUATION DATEI� DEPARTMENT 3I /zl ii f, q1 SCORE PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) LO ALARM ACTIVATION (PULL STATION PULLED,1-10) tc' DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) / p EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) Iv PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) to FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) I c' CORRIDORS(ALL ITEMS ON ONE SIDE, 1-10) 0 RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) Icy '151oriC4 ,S- OBERSERVERS: 1_45re,"C MANAGER: TOTAL Kra 9CA SCORE 10.100? 1 1 rchard HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT F•lovLLoA 'circ17r.f 1 _ DATE (7 t /a DEPARTMENT(S) /VMr5c1-40-) ATTENDEES: 1 KO ri I _ l y'J IU 3.f� nk Q CND ! Cinfk _ 4 evt,'et bel-if v,VJV 6, 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ATTENDANCE RECORD 01082016 MW 4)rchard HOSPITAL Yauw Our Priorky ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: 'V(7 //Z1 Shift: 7-3 3-11 ,x 11-7 Fire Location: N;,ryr 5 P" Observation Location: !Vv, i Time Employee found Fire Site: 2../'1S Time Announced on PA System: "/A Time Alarm Activated: ", i Time Drill completed Li/vel Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the �rQr action to be taken or at a fire, a iv1 / � �nsPh9, Define RACE. Gar it The acronym PASS indicates how PIS cl�`e� to fight the fire with an extinguisher. Define PASS. \ Socki q+`45W 3. What is the hospital code for fire CC)C - d, and how is It reported? 4. Staff knew the location of fire y _ alarms. /\ 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. l� E. Automatic Fire Doors closed. X _ 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. x 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and how to operate. Comments:' ASV tie k-A Action taken: Observer Signature: rchard HOSPITAL Youlr,Our Priorky ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: 3/17/21 Shift: 7-3 3-11 X 11-7 Fire Location: 1111,rs, 5‘414� _ Observation Location: N„rc, Time Employee found Fire Site: t•(y c Time Announced on PA System: ✓1/c, Time Alarm Activated: yt/ Time Drill completed z�q Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1 1. The acronym RACE Indicates the action to be taken or at a fire. • Define RACE. 2. The acronym PASS indicates how 0 v to fight the fire with an - . extinguisher. Define PASS. cam=v'r` 3. What is the hospital code for fire ca and how is it reported? f/ 4. Staff knew the location of fire alarms. 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. g. Automatic Fire Doors closed. I/ 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. v 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and how to operate. Comments: Action taken: Observer Signature: r1. c,:4,rch rd HOSPITAL FIRE DRILL EVALUATION ®ATE '//24/2.1 [-DEPARTMENT SCORE ✓ ,'Sc S%-G-,uv PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) fu ALARM ACTIVATION (PULL STATION PULLED, 1-10) to DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) 20 EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) Lv PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) - 10 FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) 10 CORRIDORS(ALL ITEMS ON ONE SIDE, 1-10) ( c RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) 10 OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) OBERSERVERS: MANAGiiER: TOTAL f SCORE r ' (0•100) 1`j rci rd HOSPITAL ATTENDANCE RECORD TITLE'S U BJECT t c° Is; r. 11 DATE V/Z6/L I DEPARTMENT(S) p 5e S� f► ATTENDEES: -7LE it6 1. A1��r': ' 3. uki'R y L.n L)cyyvki ly 4. aired+ (.1.11/ 1111*4-11( t 5\mut " -pA 6.12U®4� GNi1 C PM 7. ///k45 *, /s4//1---( p//7) 9. • A _ 1.1►.1,, (� ,' 41([ k/11.:..1r[�r.� C A2ft 121/wail X &du 13. 14. 15. 16. 17. 18. 19. 20. ATTENDANCE RECORD 01082016 MW -orchard HOSPITAL You're Our Priority ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: V I. /z I Shift: 7-3 3-11 11-7 Fire Location: 'Jars€ Observation Location: Nom' s\•.,\-1), Time Employee found Fire Site: (5,Li Time Announced on PA System: !.514 Time Alarm Activated:/s/, Time Drill completed /5'/3 Staff knowledge of questions 1-6 must be correct. If Incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE Indicates the action to be taken or at a fire. ;tiff Define RACE. 2. The acronym PASS indicates how to fight the fire with an extinguisher. Define PASS. l� 3. What is the hospital code for fire and how is it reported? v� �' 1i 4. Staff knew the location of fire alarms. X 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. 4/ 2. Automatic Fire Doors closed. _ 9. Patient evacuation list prepared. '( 10. Fire chimes were heard by staff. ' 11. Code Red at location of fire was heard over PA. _ 12. Personnel know zone/area, medical gas shut off valves and (uX how to operate. Comments: �' ` �� / P� r ��✓71 J Action taken: Observer Signature: rchard HOSPITAL Youle Our Primly ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: `qf2b "f Shift: 7-3 3-11 11-7 Fire Location: Pad rsr sVe,L,u" Observation Location: A✓c.rsc Timis Employee found Fire Site: /CO Time Announced on PA System: /$/y Time Alarm Activated: / 5Y5— Time Drill completed /5/g Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the I/_ action to be taken or at a fire. Y5AV1.. Define RACE. v ��0 <20-1-11/04. 2. The acronym PASS indicates how to fight the fire with an extinguisher. Define PASS. V - 3. What is the hospital code for fire and how Is it reported? r� G OCA 4. Staff knew the location of fire Vial ( alarms. 5. Staff knew the location of the fire 10%97 vvu:ik7 k\ t I5 extinguishers. 6. Staff knew evacuation route, fire , / € ( o' ha 1/5 exits, & location of emergency V 1AIP '9"4— egress directory. _ .Y 7. Staff closed all doors and windows. 8. Automatic Fire Doors closed. ‘V- 9. 9. Patient evacuation list prepared. Y 10. Fire chimes were heard by staff. V 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and \\/\ how to operate. Comments: 11//1x ' Action taken: Observer Signature: ‘, , J h d HOSPITALFIRE DRILL EVALUATION DATE 7/22/ DEPARTMENT 2 SCORE I-�oLA,e) el" r 4Ial PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) /0 ALARM ACTIVATION (PULL STATION PULLED, 1-10) 10 DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) 2-0 EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) 10 FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) 1c7 CORRIDORS(ALL ITEMS ON ONE SIDE,1-10) /c2 RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) to OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) OBERSERVERS: Lcej MANAGER: Tom'. SCORE f M Vc.r1 (o.1oD) lap S'..rr — to 1 T 1625 4rchard HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT M,,.l,. r, pr•IA DATE ?/ -7rr 1 DEPARTMENT(S) !VLrsc ?\'J4t on ATTENDEES: yy +�0*d't ' '. ':7' -C a}•, Yi'•1: ,.F :.;:�. :1"#'�'' ,'I:`�I"T' ,1. -7)- 2.kisia, ..., ,/ 9. 4. \ I ,. ' 0' 4C_Cc- * 5. AaNITA WNW N'JA I& r\ n(pL C'K{� 4214 H /„ 4 '— R • 4irtf*tyjc 4 -,- -.: ,-- RAmmili- ups 12S)A0AvtioA l'. (L°S--- _ - 13. 14. 15. 16. 17. 18. 19. 20. ATTENDANCE RECORD 01082016 MW 4rchard HOSPITAL Youlra Our Priorly ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: '/z7(2 ( Shift: V 7-3 3-11 11-7 Fire Location: MLrsc Observation Location: 14,-or NAP,' _ Time Employee found Fire Site: Ibioi Time Announced on PA System: 11>Z0 Time Alarm Activated: 1070 Time Drill completed Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the Rc action to be taken or at a fire. Define RACE. 2. The acronym PASS indicates how P to fight the fire with an F-►rti extinguisher. Define PASS. S 3. What is the hospital code for fire and how is it reported? e>'.ee 4. Staff knew the location of fire _ alarms. v1f 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency 1� egress directory. leis 7. Staff closed all doors and windows. ye A. Automatic Fire Doors closed. \-te-5 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. Y-5 11. Code Red at location of fire was heard over PA. IL yes 12. Personnel know zone/area, medical gas shut off valves and 0) how to operate. Comments: ' 11 ,M,,,,,,cs, Action taken: Observer Signature: -406 rchard HOSPITAL You're Our Priority ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date; 7/ 27/2 f Shift: \ 7-3 3-11 11-7 Fire Location: 11./L.r-c Observation Location: 5\-c.' 0✓1 Time Employee found Fire Site: /01'I Time Announced on PA System: /020 Time Alarm Activated: /©2 c' Time Drill completed .! 'Z3 Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the (\teryv., action to be taken or at a fire. con V.:h f)t .;vi5t Define RACE. 2. The acronym PASS indicates how (f,iy\ ,,,.. to fight the fire with an 51.--ccy extinguisher. Define PASS. 3. What is the hospital code for fire and how is It reported? _ cod(` cc 4. Staff knew the location of fire } alarms. 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. 0� t#. Automatic Fire Doors closed. k 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. _ 11. Code Red at location of fire was I Loa< ,"47., heard over PA. X 12. Personnel know zone/area, medical gas shut off valves and r1l1 -4 how to operate. Comments: Action taken: Observer Signature: 1 ,4„ .4rchard HOSPITAL FIRE DRILL EVALUATION DATE /9/.3(/z( DEPARTMENT Ait,/'Sr_ SCORE PA ANNOUNCEMENT(CODE RED ANNOUNCEMENT 3X TO DEPT, 1-10) to ALARM ACTIVATION (PULL STATION PULLED, 1-10) DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) go ' EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) to PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) la CORRIDORS(ALL ITEMS ON ONE SIDE, 1-10) - to RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) cO OTHER OBSERVATIONS (ATTITUDE,COMPLAINTS, EFFICIENCY, ETC., 1-10) Cv OBERSERVERS: MANAGER: TOTAL 3 L SCORE (a•xoo) l0e, IF frOil �� - 151f rchard HOSPITAL You'm Our Priorky ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: g/3/tz] Shift: 7-3 k 3-11 11-7 Fire Location: Observation Location: /V'.r;c A.0-1 Tim°"e Employee found Fire Site: /1'o'1 Time Announced on PA System. 1 5b(1 Time Alarm Activated: /-, Time Drill completed /i7 Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE indicates the �� ►-s action to be taken or at a fire. i}lwrw Define RACE. co` '�' '4IGAic,51, 2. The acronym PASS indicates how PGS to fight the fire with an • extinguisher. Define PASS. 3. What is the hospital code for fire V Coc l and how is it reported? c r-2t 4. Staff knew the location of fire _ alarms. 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. g. Automatic Fire Doors closed. ( 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. }� 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and how to operate. / Comments: Action taken: Observer Signature: A06 HOSPITAL You1e Our Priority ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: 973/ /2,i Shift: 7-3 )C 3-11 11-7 Fire Location: it,,sr Observation Location: /t c.jcc Time Employee found Fire Site: /rti`/ Time Announced on PA System: /SAY Time Alarm Activated: /S Time Drill completed / c/i Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator ' Yes No Comments Score 1. The acronym RACE Indicates the fkA c E Rest.- action to be taken or at a fire. ict-tir Define RACE. 2. The acronym PASS indicates how P to fight the fire with an V /Y1 extinguisher. Define PASS. `5q E14-4 3. What is the hospital code for fire Red and how is it reported? 4. Staff knew the location of fire _ alarms. 5. Staff knew the location of the fire \/ 114 extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. $. Automatic Fire Doors closed. V 9. Patient evacuation list prepared. V 10. Fire chimes were heard by staff. ✓ 11. Code Red at location of fire was N 4 WA" heard over PA. 12. Personnel know zone/area, medical gas shut off valves and NZ how to operate. Comments: Action taken: Observer Signature: ' Archard HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT 1- ' Pr.V DATE (37 /2/ DEPARTMENT(S) AA-4,5c A4, -N ATTENDEES: •i-i: ilriti ,Si_•;q' • 'r' :`i11Mfsei10.i? • ;y:.WI;f:;7?-: r i..i-s!.• , ;i( ; 1. t-baSe,6e.filn ��itmet� QeU 3. /r AGi ,0UEf,# R Lwil 4. - —sI Sif10 UJ liiiw►i► M M WM 5(Vole_ A) Do ii.3.110 1 Chik"`"•-• Ci.dca0 no . 6(R&S 1-e .RY* . !ei 'A . i 7.4 8 vllujcArw,ree, _ eldi IKI Dd Ar 9 11, rtikr_. litolifiecii.„---L.-k_ c_Ne- . 1. .po )6" , isii id, GN IT 11. I� \'C,n n cyet� ``i,') i Qisl P11 izT 13. mootu" ilir .-- C n n 1 7101 ti/llt l/R f'`A G� ?F- ss. K1ek) Moo& 11.,---. L VN 165 ")::_iitor, ,_))s_t___ 17. nE-b!efr- S�nc��a�n L, 18. 19. 20. ATTENDANCE RECORD 01082016 MW ee yZ: • HOSPITAL FIRE DRILL EVALUATION DATE I(z7 w DEPARTMENT ` ) , SCORE PA ANNOUNCEMENT(CODE RED ANNO�INCEMENT 3X TO DEPT, 1-10) Ca ALARM ACTIVATION (PULL STATION PULLED, 1-10) t0 DOORS AND WINDOWS(SHUT ALL DOORS AND WINDOWS, 1-20, 1PT. EACH) EVACUATION PLANS(CURRENT EVACUATION PLAN IN DEPT. 1-10) Lo PULL STATIONS(UNOBSTRUCTED ACCESS TO PULL STATION, 1-10) - 1a FIRE EXTINGUISHERS(UNOBSTRUCTED ACCESS TO FIRE EXTINGUISHERS, 1-10) 1a CORRIDORS(ALL ITEMS ON ONE SIDE, 1-10) Lb RESPONSE(NUMBER OF RESPONDERS W/FIRE EXTINGUISHER, 1-10) OTHER OBSERVATIONS (ATTITUDE, COMPLAINTS, EFFICIENCY, ETC., 1-10) L rr ` !r y+ C _ �['�rr�1 r� rJv'' �"J_� }rC kc) ;;f! L. Li 1 OBERSERVERS: (111 MANAGER: TOTAL SCORE .'1 _(0-10Q) L 1(90 4jrchard HOSPITAL Youire Our Priority ORCHARD HOSPITAL FIRE ALERT OBSERVATION REPORT Date: q /27 /2.I Shift: 7-3 3-11 K 11-7 Fire Location: Observation Location: Tim Employee found Fire Site: Time Announced on PA System: Time Alarm Activated: Time Drill completed Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No Comments Score 1. The acronym RACE Indicates the ReSGve kCtCv' i action to be taken or at a fire. CO,A\o - E,Cis; h Define RACE. 2. The acronym PASS indicates how RA,\� / ,v11 Slfrc,cfy to fight the fire with an sr.,icep extinguisher. Define PASS. 3. What is the hospital code for fire Cedar_ ee.4 and how is it reported? 4. Staff knew the location of fire alarms. 5. Staff knew the location of the fire ihc extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency egress directory. 7. Staff closed all doors and windows. S. Automatic Fire Doors closed. M ,/ 9. Patient evacuation list prepared. L/ 10. Fire chimes were heard by staff. 11. Code Red at location of fire was heard over PA. 12. Personnel know zone/area, medical gas shut off valves and 4, how to operate. Comments: PaeLe.sr Action taken: ObserverSignature: 5 e YlarvC. Far Vel i)rchrd HOSPITAL You're Our Priorky ORCHARD HOSPITAL EIRE ALERT OBSERVATION REPORT Date: Cf 7 2 7(21 Shift: 7-3 3-11 ' 11-7 Fire Location: it'.rcc Observation Location: Timt Employee found Fire Site: Time Announced on PA System: Time Alarm Activated: Time Drill completed Staff knowledge of questions 1-6 must be correct. If incorrect, Remedial Training will be given. Indicator Yes No ' Comments Score 1. The acronym RACE indicates the re_5CYck J ,^, action to be taken or at a fire. CP--f"—"'bj Define RACE. 2. The acronym PASS indicates how Lac I a to fight the fire with an ' SQ extinguisher. Define PASS. 3. What is the hospital code for fire Co AC r-c,t and how is it reported? 4. Staff knew the location of fire alarms. 5. Staff knew the location of the fire extinguishers. 6. Staff knew evacuation route, fire exits, & location of emergency [/- egress directory, 7. Staff closed all doors and windows. Et. Automatic Fire Doors closed. (/ 9. Patient evacuation list prepared. 10. Fire chimes were heard by staff. ✓/ 11. Code Red at location of fire was heard over PA. • V 12. Personnel know zone/area, medical gas shut off valves and how to operate. Comments: (,„„.re,f-- x, l( Action taken: Observer Signature: Walt 5cierrq-, rch rd HOSPITAL ATTENDANCE RECORD TITLE/SUBJECT Tete 1), k'1 ,.!