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STIHC Safety Drill Report
This form is used for the official report following a Safety Drill. If you're a STIHC employee and would like to report an actual Safety Incident, please use the incident report form in Medtrainer.
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Date
MM
/
DD
/
YYYY
Time
Time
:
AM
PM
Actual Event or Drill?
Actual Event
Drill
Clear selection
Type of Event/Drill
Fire
Adult Code
Pediatric Code
Abducted Child
Bomb Threat
Violent Patient
Earthquake and Tsunami
Clear selection
Facility
All STIHC facilities
Primary Care and Administration
Dental Clinic
Wellness Center
Patient Transport and DSHS Trailer
Scenario
Your answer
Description of Event/Drill
Your answer
Observations and Areas for Improvement
Your answer
Specific Plan to Address Improvements Needed
Your answer
List all Staff who Participated
Your answer
Name of person submitting this report
Your answer
Submit
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