October, 1993
Information Bulletin 93-5
ICF/MR
Fire Drill Report Form For ICF/MR Facilities
The Minnesota Departments of Health (MDH) and Public Safety (DPS) have developed a Fire Drill Report for ICF/MR Facilities. This form contains the information needed by both Departments in conducting the annual recertification survey. In addition, this same information is used in determining the current Evacuation Difficulty Index (E-score) for those facilities not classified Impractical .
A copy of this form and instructions for completing it may be obtained by calling the Minnesota Department of Health, Health Policy, Information and Compliance Monitoring Division at (651) 201-3710. The use of this form is voluntary. The form may be copied as needed.
Impractical Facilities:
Impractical facilities are not assigned an E-score. Therefore, the information provided by the form would be used only for the recertification survey.
Prompt and Slow Facilities:
The information provided by the form would be used in determining the facilities current E-score and in the recertification survey.
If you have any questions regarding the use of this form, please contact either: (MDH) James P. Loveland, P.E., Program Manager, Engineering Services Section at (651) 201-3710 or (DPS) Robert Imholte, Supervisor, Deputy State Fire Marshal at (320) 685-8559.
