| Provider/Program ________________________________________________________________
Address _______________________________________________________________________ City/Town __________________________________ Total Enrollment ______________________ |
||||||||
Date |
Time |
Number |
Name of |
Exit Route Followed |
Comments (Include weather or other conditions that impact the fire drill) |
|||
Start |
End |
P |
S |
O |
||||
| 1. __/__/__
MTWTHF |
||||||||
| 2. __/__/__
MTWTHF |
||||||||
| 3. __/__/__
MTWTHF |
||||||||
| 4. __/__/__
MTWTHF |
||||||||
| 5. __/__/__
MTWTHF |
||||||||
| 6. __/__/__
MTWTHF |
||||||||
| 7. __/__/__
MTWTHF |
||||||||
| 8. __/__/__
MTWTHF |
||||||||
| 9. __/__/__
MTWTHF |
||||||||
| 10. __/__/__
MTWTHF |
||||||||
| 11. __/__/__
MTWTHF |
||||||||
| 12. __/__/__
MTWTHF |
||||||||
*Adapted from New York State Office of Children and Family Services Form.
