*MCLAREN FLINT - Fire Incident Report

1. Date of Code Red*

2. Time of Code Red *

3. Location of Code Red*

If Other, Please Specify

5. Full Name of Observer*

6. Email of Observer *

6a. Secondary email address (to receive confirmation)

7. Was Observer's department open at time of Code Red?*

1. Did staff of Observer's department close all fire doors in the area, including patient room doors?*

2. Were the corridors of Observer's department clear & free from obstructions?*

3. Did staff of Observer's department inform patients/visitors of the alarm condition?*

*If "No" is indicated for questions in this section, please enter manager

1. Was the page audible within Observer's department?*

2. Did all automatic doors within Observer's department close and latch properly?*

3. Were fire alarm devices (strobes, etc.) within Observer's department functioning properly?*

*If "No" is indicated for questions in this section, please enter the McLaren Flint Engineering Requests Work Order # submitted by Observer

Date Observer completes form:

Time Observer completes form: