Family Child Care Sample Forms Packet Page 4

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Evacuation/Smoke Detector Logs
You must conduct evacuation drills at least once (1) per month from each approved floor level. This
sample form also contains a Smoke Detector Log to document your monthly test of your smoke
detectors. These logs will be checked by a licensor on home visits.
EVACUATION LOG
Month/Date
Time
# of Children
Floor Level
Exit Used
Meeting Place
Effectiveness of Drill
(Including how long it took)
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
SMOKE DETECTOR LOG
Floor Level/Location
Smoke Detector Tested
Date Batteries Replaced
Month/Date
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Page 4 of 12
FCCSampleFormPacket20100203

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