Fire Drill Report Form for ICF/MR Facilities - Minnesota Dept. of Health

October, 1993

Information Bulletin 93-5

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.

Updated Thursday, March 17, 2011 at 11:19AM