Form 7263
May 2018-E
Emergency Practices
Providers may use this form or their own form to document emergency practices including evacuation, sheltering in place, and lock-down drills.
Directions: To complete this form, the designee documents the dates drills were performed, the exit times, and the dates that smoke detectors
and carbon monoxide detectors were inspected. Licensing will review the form at your inspections. If you need additional assistance, email the
Minimum Standards Comments mailbox.
Fire Drill: Evacuating the children and caregivers to a designated safe area in an emergency such as a fire. The children must be able to
safely exit the building within three minutes. You must practice a fire drill every month.
Sheltering/Severe Weather: Taking shelter within the center to temporarily protect children and staff from situations such as a tornado.
Sheltering can also be used when an endangering person is in the area, though not on the premises. You must practice a sheltering/severe
weather drill four times in a calendar year.
Lock-Down Drill: Keeping children and staff in place to protect them from a volatile person on the premises. You must practice a lock-down
drill four times in a calendar year.
Battery Powered Lighting is Located in Each Child Care Room – Check the Batteries
Fire Extinguishers
Location of Fire Extinguishers:
Relocation Site
Relocation Site for Children and Staff after Evacuating Operation:
Sheltering/Severe Weather Drill and Lock-Down Drill (4 times per year)
Month Date and Time Staff Initials
Exit Time
S= Shelter SW = Severe Weather LD = Lock-Down
January
February
March
April
May
June
July
August
September
October
November
December
Form 7263
Page / 05-2018-E
Fire Drills
Month Date and Time Staff Initials Exit Time
January
February
March
April
May
June
July
August
September
October
November
December
Carbon Monoxide (CO) Alarm Detector, Smoke Detector Test, and Fire Extinguisher Check
Month CO Alarm Detector Test Date Smoke Detector Test Date Fire Extinguisher
January
February
March
April
May
June
July
August
September
October
November
December
First Aid Kit
Location of First Aid Kit:
Operation Inspections
Fire: Health: Gas:
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