Fire Drill Log
Professional Fire Drill Log template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Fire Drill Log
TEMPLATE • Inspection-Ready AFH Standard
1. Drill Date, Time & Evacuation Scenario
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. Evacuation Time & Resident Count
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Equipment Check & Drill Evaluation Notes
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (3 Sections)
Drill Date, Time & Evacuation Scenario
Day/night drill designation, simulated fire location, and weather conditions.
Evacuation Time & Resident Count
Total elapsed time (minutes/seconds), number of residents evacuated, staff involved.
Equipment Check & Drill Evaluation Notes
Smoke detector test, alarm audibility, obstacles encountered, and provider sign-off.
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