"Child Care Fire Drill Report Template - Scdss Child Care Licensing"

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SCDSS Child Care Licensing
Fire and Life Safety Office
2638 Two Notch Rd. Suite 217
Columbia, SC 29204
Child Care Fire Drill Report
1.
Facility Name:
___________________________________________________
Street Address:
___________________________________________________
City/State/Zip:
___________________________________________________
2.
Person conducting drill: ____________________________________________
3.
Date of drill: ______________________Time: _____________________
4.
Method used to notify occupant of drill: ________________________________
Sunny
Cloudy
Raining
5.
Weather Condition:
Windy
Calm
_____ Temperature
Fire Department notified: Yes
No
6.
Telephone
Fire Alarm System
If so, how?
7.
Staff members on duty: ______________________________________
8.
Number of occupants evacuated:
_____ Students
_____ Faculty/Staff
Yes
No
9.
All rooms searched to insure evacuation of all:
Yes
No
10. Everyone gathered at designated meeting place:
11. Total time to evacuate: ___________ Total time for accountability ______________
12. Remarks: (special conditions; problems encountered; etc.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Exit Signs Checked: OK ________
Emergency Lights Checked: OK ________
Number
Number
A record of all fire exit drills shall be kept on the premises. The following minimum information is
required per the International Fire Code 405.5:
Identity of person conducting drill.
Any special conditions simulated.
Date and Time of drill.
Problems encountered.
Notification method.
Weather conditions.
Staff members on duty and participating.
Time required for complete evacuation
Number of occupants evacuated.
SCDSS Child Care Licensing
Fire and Life Safety Office
2638 Two Notch Rd. Suite 217
Columbia, SC 29204
Child Care Fire Drill Report
1.
Facility Name:
___________________________________________________
Street Address:
___________________________________________________
City/State/Zip:
___________________________________________________
2.
Person conducting drill: ____________________________________________
3.
Date of drill: ______________________Time: _____________________
4.
Method used to notify occupant of drill: ________________________________
Sunny
Cloudy
Raining
5.
Weather Condition:
Windy
Calm
_____ Temperature
Fire Department notified: Yes
No
6.
Telephone
Fire Alarm System
If so, how?
7.
Staff members on duty: ______________________________________
8.
Number of occupants evacuated:
_____ Students
_____ Faculty/Staff
Yes
No
9.
All rooms searched to insure evacuation of all:
Yes
No
10. Everyone gathered at designated meeting place:
11. Total time to evacuate: ___________ Total time for accountability ______________
12. Remarks: (special conditions; problems encountered; etc.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Exit Signs Checked: OK ________
Emergency Lights Checked: OK ________
Number
Number
A record of all fire exit drills shall be kept on the premises. The following minimum information is
required per the International Fire Code 405.5:
Identity of person conducting drill.
Any special conditions simulated.
Date and Time of drill.
Problems encountered.
Notification method.
Weather conditions.
Staff members on duty and participating.
Time required for complete evacuation
Number of occupants evacuated.