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Get PA Personal Care Home Fire Drill Record

Ed (list each exit used) Commonwealth of Pennsylvania Department of Public Welfare # Res in home (at time alarm sounds) # Res Evacuated # Staff Participating Was Alarm Activated Was Alarm Operative Any Problems Planned Corrective Action DPW 10/10 ADULT RESIDENTIAL LICENSING – PERSONAL CARE HOME FIRE DRILL RECORD ADDENDUM – 55 Pa.Code § 2600.14(a) This form is to be used by homes serving residents who have mobility needs Date of Fire Drill: Name of Resident who has Mobility Needs .

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