Survey Date Month Day Year Surveyed ByFacility NameAlarm Systems1. Do you have an alarm system?SelectYesNoTypes of alarms installedDuress/Panic Front Desk Staff Room Exam Rooms Other OtherFire Smoke Detectors Heat Detectors Rate-of-Rise Detectors Other OtherIntrusion Door Contacts Window Contacts Glass Break Sensors Other OtherMotion Detectors Sound Threshold/Microphones Other OtherIntegrated Visual Alarm Emergency Strobe Lights Bathrooms Instrument Wrapping Room Procedure Rooms Administrative Offices Hallways Are fire alarms monitored? By Fire Department By Police/Sheriff By Alarm Monitoring Company Are security alarms monitored? By Police/Sheriff By Alarm Monitoring Company Is there a monitoring contract in place? Yes No Do all personnel have individual alarm codes? Yes No Are alarm codes updated regularly? Written policy in place Point of Contact lists current internally and with alarm company
