Mecklenburg County Fire Marshal’s Office
Fire & Evacuation Drill Report
2145 Suttle Avenue
Charlotte, NC 28208
Office (980) 314-3070
Revised 4/30/15
Facility Name
Facility Address
Facility Contact
Facility Telephone
Date
FMO Representative or Drill Evaluator
Telephone
Area or Floor(s) of Drill
Time
*FOLLOW DIRECTIONS FOR PLANNING AND CONDUCTING A FIRE DRILL ON THE FOLLOWING PAGE*
General Fire or Evacuation Drill
Nursing Care or Assisted Living Facility
Occupants react to the fire alarm,
10 7 4 0
begin immediate evacuation
Staff begins search, assignment,
10 7 4 0
assists persons with special needs
Doors to fire area and other room
10 7 4 0
and areas closed but not locked
Occupants, employees and visitors
10 7 4 0
use proper methods of egress
Occupants and visitors directed to,
10 7 4 0
and remain in safe assembly area
Method to account for all employees 10 7 4 0
and visitors
Someone takes charge of evacuation 10 7 4 0
& gives assignments
All fire doors and other fire & life
10 7 4 0
safety equipment operates properly
Call from facility to 911
10 7 4 0
Time Received ____________
Hallways, corridors and paths of egress
5 2 0
are clear and accessible
TIME
Up to 5:00 = 5 5 2 0
________:________
5:01 – 7:00 = 2
Minutes Seconds
> than 7:00 = 0
Score – Add columns together and
%
enter total
(100-93, Excellent) (92-82, Good)
(81-70, Acceptable) (69 and below, Unacceptable)
All persons removed from fire room or
10 7 4 0
immediate danger to a safe area
Door to fire room and doors to other
10 7 4 0
rooms or areas closed but not locked
Fire alarm activated manually without
10 7 4 0
delay or automatic activation occurs
Fire location communicated to staff by
10 7 4 0
page announcement or other method
Staff reports to area of alarm to assist and
10 7 4 0
search, or begins assigned duties
Hallways, corridors, exit doors and path of 10 7 4 0
egress cleared of obstructions
A representative took charge and made
10 7 4 0
assignments as necessary
All fire doors and other fire & life safety
10 7 4 0
equipment operates properly
Call from facility to 911
10 7 4 0
Time Received ____________
Call from alarm company to 911
5 2 0
Time Received __________ (within 2 minutes)
TIME
Up to 4:00 = 5
5 2 0
________:________
4:01 to 5:30 = 2
Minutes Seconds
> than 5:30 = 0
Score – Add columns together and enter
%
total
(100-93, Excellent) (92-82, Good) (81-70, Acceptable)
(69 and below, Unacceptable, re-drill required)
Comments:
FMO Signature:
Facility Representative Signature:
Planning and Conducting a Fire Drill
Fire and Evacuation Drill
Frequency and Participation
Group or Occupancy
Group A: Assembly
Group Bc: Business
Group B: Business
Group E: Educational
Group I: Institutional
Group R-1: Hotels/Motels
Group R-2d: Apartments/Dorms
Group R-4: Assisted Living
(between 5-16 people)
a.
b.
c.
d.
Frequency
Participation
Quarterly
Annually
Quarterly
Monthlya
Quarterly on each shift
Quarterly on each shift
Four annually
Employees
Employees
All occupants
All occupants
Employeesb
Employees
All occupants
Quarterly on each shift
Employeesb
In severe climates, the fire code official shall have the authority to modify the emergency evacuation drill frequency.
Fire and evacuation drills in residential care assisted living facilities shall involve the actual evacuation of residents to a selected assembly point and
shall provide residents with experience in exiting through all required exits. Where occupants receive habilitation or rehabilitation training, fire
prevention and fire safety practices shall be included as part of the training program.
Group B buildings having an occupant load of 500 or more persons or more than 100 persons above or below the lowest level of exit discharge.
Applicable to Group R-2 on-campus college student housing facilities, including fraternity and sorority houses.
1. Make sure that all staff and/or occupants have had training on your fire evacuation plan.
2. Call the Mecklenburg County Emergency Communications Center at (704) 943-6200 and tell them you are going
to conduct a fire drill. Provide you name, business name, business address, business telephone number and any
other requested information.
3. Call you alarm monitoring company and have them take your fire alarm monitoring status “off-line” or on “test”
while you conduct your drill.
4. Begin your drill with sounding the fire alarm system. The person assigned to call 9-1-1 should actually do so, and
report that the facility is conducting a fire drill and that the alarm is sounding. Answer any questions that the 9-1-1
operators may ask.
5. Time the drill beginning with the alarm activation.
6. Once everyone has exited the building stop the time.
7. Once the drill has stopped, silence and reset the fire alarm system.
8. Judge the actions and performance of the staff and/or occupants using the criteria on the Fire Drill Report Form.
Criteria performed in an exceptionally high, timely and efficient manner should be scored in the “10 point” block.
Criteria met and performed as expected should be scored in the “7 point” block. Criteria met and performed
below expected should be scored in the “4 point” block. Criteria missed or performed poorly should be scored in
the “0 point” block. Add the scores together and record it on the form. Use the score ranges on the form to
evaluate the overall drill performance. Use the comments section to provide feedback to the staff and/or
occupants. Provide training and re-drill as needed to reach an acceptable level of performance.
9. Call your alarm monitoring company and have them put your system back “on-line”.
10. Call the Mecklenburg County Emergency Communications Center back at (704) 943-6200 and report that the drill
is completed and that the fire alarm system is back “on-line” and to resume normal dispatch.
11. Provide a critique of the drill to the staff and/or occupants.
12. Occupancies required to conduct fire drills mandated by the North Carolina Fire Code referenced in the table
above should send the original copy of the Fire Drill Report to the address on the front of the form with ATTN: to
the Assistant Fire Marshal assigned to your area. To find the Assistant Fire Marshal assigned to your area please
visit the link listed below. Keep your copy available for review by the Fire Marshal’s Office or by licensing or
regulatory agencies.
Fire Marshal’s Office