BROTHERS AND KEEPERS CORPORATION
EMERGENCY & PREVENTION DRILL (Weekly attest and Drill)
Facility Address
*
Lincoln House: 1317 N. Rochester, Mesa, Az 85205
Moses House: 603 N. Vista Del Sol, Mesa, Az 85207
Leah’s Place: 7317 S. Palm Dr., Tempe, Az 85283
Blake's Place: 4636 E. Stanford Ave, Gilbert, Az 85234
Kirkland House: 3947 W. Kirkland Ave, San Tan Valley, Az 85142
Russo House: 1375 E. Victoria St. Chandler, AZ 85249
Remi's Place: 2830 S Chatsworth, Mesa AZ 85212
Fire Drill Date
*
-
Month
-
Day
Year
Date Picker Icon
Type of Drill
*
Fire Drill (Monthly)
Bomb Threat Drill (Annually)
Disaster Drill (Natural Disaster)
Medical Emergency (Annually)
Aggressiveness Awareness (Table Talk)
Technology Outage
Other
Time of Drill
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Time of Completion
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Smoke Alarms / CO2 Cleaned Tested, and Batteries Replaced?
*
Yes
No
Carbon Monoxide Alarm must be tested on a weekly basis
Carbon Monoxide Tested and Batteries Replaced?
*
Yes
No
Generator Needed
*
Yes
No
Notes regarding Smoke Alarm and/or Carbon Monoxide Testing
*
Location of Practice Fire
*
Meeting Location
*
Exits used for Egress
*
FRONT DOOR
BACK DOOR
SIDE DOOR
GARAGE DOOR
Other
Problem Notes
*
Measures taken to ensure that children understand the purpose of a drill and their responsibilities during a drill.
*
Yes
No
Other
Did ALL YOUTH Participate?
*
Yes
No
If NO, Explain:
List All Participants
*
Staff Name
*
First Name
Last Name
House Manager Email
joseph@brothersandkeepers.com
nichole@brothersandkeepers.com
eliza@brothersandkeepers.com
nicole@brothersandkeepers.com
miguel@brothersandkeepers.com
diana@brothersandkeepers.com
eric@brothersandkeepers.com
BKC Staff Signature
*
Date
*
/
Month
/
Day
Year
Date Picker Icon
Submit
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