FIRE, TORNADO AND SHELTER-IN-PLACE DRILL REPORT FORM
School Name: Madison Academy Academic Year: 2015-16
School Administrator Signature - (signed) Tricia Osborne
****MCL.29.19 states in part that: 5 five drills are required (3 by Dec. 1, 2 after Dec. 1), 2 tornado drills (1 in March), 3 shelter-in-place drills (1 by Dec. 1, 1 after Jan 1, 1 your choice). One drill must be during lunch, recess, or another time when students are gathered outside of the classroom.****
FIRE (5 total):
3 Fire Drills Before December 1:
| Fire Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 1 of 5 | 9/10/15 | 1:13 | Tricia M Osborne | singed | Best yet - Good start |
| 2 of 5 | 10/13/15 | 9:16-9:18 | Tricia M Osborne | singed | make sure to remind K and PreK teacher to check internal bathrooms |
| 3 of 5 | 11/20/15 | 1:38 10:02-10:04 |
Tricia M Osborne | signed | keep close all doors as they exit |
| Fire Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 4 of 5 | 3/17 | 1:56-1:58 | Tricia M Osborne | singed | Mr. Martin's door was locked - reminded him that it needed to be unlocked during drill to check for students |
| 2 of 5 | 4/19 | 1:14-1:16 | Tricia M Osborne | singed | Amazing job! During assembly |
TORNADO (2 total):
1 Tornado Drill in March
| Tornado Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 1 of 2 | 9/16/15 | 1:12 3:32 sec |
Tricia M Osborne | singed | Middle school needs to practice walking out of rooms 2 by 2 |
| Tornado Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 2 of 2 | 3/24/16 | 8:28 3:12 sec |
Tricia M Osborne | singed | Remind long term sub of class placement |
SHELTER-IN-PLACE (3 total):
1 Shelter-In-Place by December 1
| Drill Numberr | Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 1 of 3 | 9/23 | 2:12-2:14 | Tricia M Osborne | singed | gas leak |
1 Shelter-in-Place after January 1:
| Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 2 of 3 | 2/23 | 1:30-1:32 | Tricia M Osborne | singed | intruder |
1 Additional Shelter-in-Place:
| Drill Number |
Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Comments |
| 3 of 2 |
***Which of the above listed drills took place during recess, lunch or another time when students are gathered outside of the classroom?
| Drill Type (Fire, Tornado, Shelter) | Date | Time | Name of Individual in Charge of Drill |
Signature of Principal/Designee | Lunch, Recess, other? Please specify |
| Shelter in Place | 10/12 | 12:40 | Tricia M Osborne | singed | Lunch |
| Fire Drill | 4/19 | 1:14-1:16 | Tricia M Obsborne | signed | Assembly |