LifeSafetyWiki · Samektra
Hospital fire safety unit orientation
Hospital Fire Safety: RACE, PASS and Defend in Place — employer practical training and certification record
The employee below completed the online portion of hospital fire safety training on LifeSafetyWiki. Complete Parts 1 and 2 with them on their unit, then sign Part 3. Keep this form with the employee’s training record.
Part 1 — Your site (filled in by the employer)
| Fire code phrase and emergency numberWhat staff say and dial (NFPA 101 19.7.2.3) | |
|---|---|
| Nearest manual pull stationsLocations on this unit | |
| Nearest extinguishers and typeABC, K (kitchen), others | |
| Smoke barrier doors and next compartmentWhere patients move first | |
| Medical gas zone valvesLocation — and who may close them, when | |
| Evacuation route and area of refugeHorizontal first, then vertical |
Part 2 — Hands-on check (by the unit manager or safety officer)
| The employee showed they can | OK | Not yet |
|---|---|---|
| Point out the nearest pull station and say the code phraseNFPA 101 19.7.2.3 | ☐ | ☐ |
| Point out the nearest extinguisher and describe PASSOSHA 1910.157(g) | ☐ | ☐ |
| Close a patient room door and a smoke barrier door, and explain whyNFPA 101 19.7.2.1.2 | ☐ | ☐ |
| Walk the horizontal evacuation route to the next smoke compartmentNFPA 101 19.7.2.2 | ☐ | ☐ |
| Describe their role in the unit’s fire safety planNFPA 101 19.7.1.2 | ☐ | ☐ |
| Hands-on extinguisher training, if designated to fight firesOSHA 1910.157(g)(4) | ☐ | ☐ |
Part 3 — Certification
I certify that the employee named above was instructed in their duties under this hospital’s fire safety plan and in life safety procedures and devices on this unit (NFPA 101 2012 §19.7.1.2 and §19.7.1.8).
Keep with the employee’s annual training record. Surveyors interview staff on their fire responsibilities (The Joint Commission PE.03.01.01 EP 4; CMS K711). This form does not replace the employer’s own program, and LifeSafetyWiki does not certify competence. Not an OSHA Outreach (10/30-hour) card.