How to Fill Out the Texas Fire Drill Report (Form 4719)

Texas Form 4719 is the one-page fire drill report that HHSC-regulated facilities complete after each fire drill and keep on-site for licensing inspectors. The Texas Health and Human Services Commission publishes it as a free PDF, and it applies to childcare centers, residential child-care operations, and other licensed facilities under HHSC oversight. The form has two halves: a pre-drill planning section you fill in before the alarm sounds, and a post-drill evaluation you complete immediately after.

Where to Download the Form

The form lives on the HHSC website at hhs.texas.gov under the title “Form 4719, Fire Drill Report,” which links to the PDF.1Texas Health and Human Services. Form 4719, Fire Drill Report Print enough copies to cover a year of monthly drills, or save a digital master you can reprint.

Before you sound the alarm for any drill, check one thing: if your fire alarm automatically transmits a signal to the fire department or a monitoring company, notify them in advance so trucks aren’t dispatched to a drill.2Texas Health and Human Services. Fire Drill Report

Completing the Pre-Drill Section

The top half of the form is labeled “Complete this section before conducting the drill.” You’re building the scenario here so the drill simulates a realistic emergency rather than a formless walk outside. Every question is checkbox-based, and you check every answer that applies.

  • Question 1, Simulated Situation: Fire, Smoke, or Other with a write-in line. Routine monthly drills usually check Fire.
  • Question 2, Location: where the simulated fire starts. Kitchen, Dining, Lobby, Office, Bedroom, or Other. Vary this from month to month.
  • Question 3, Type of Fire: Bed, Wastebasket, Kitchen Range, Laundry, or Other. Pick one that fits the location.
  • Question 4, Extent of Fire: Large, Small, Explosion, Electrical, Paper, Wood, Controllable, or Other. More than one may apply.
  • Question 5, Extent of Smoke: Noxious, Whole Room, Corridor, Heavy, Light, Smoldering, or Other.
  • Question 6, Exits Used: Front Door, Back Door, Side Door, Garage Door, Window, or Other. Check the exits that correspond to the safest route from your simulated fire.
  • Question 7, Rally Point: a fill-in line for the specific gathering spot. The form itself suggests examples like “in front of neighbor Smith’s house” or “street sign.” Be specific enough that someone unfamiliar with the building could find it.

Finish this section completely before sounding the alarm. The scenario details drive how staff and occupants respond, and an inspector reviewing a year of forms will look for variety. Twelve identical kitchen-fire, front-door drills in a row suggests the scenarios aren’t actually testing preparedness.2Texas Health and Human Services. Fire Drill Report

Completing the Post-Drill Evaluation

The bottom half documents what actually happened. Fifteen numbered items, most yes/no, a few short-answer, followed by a Comments/Problems narrative. Do this immediately after the drill while details are fresh.

  • Question 1: Did staff use proper judgment during the drill?
  • Question 2: Short-answer describing the actions staff took.
  • Questions 3 and 4: Whether the fire department was called, and at what time.
  • Question 5: Were residents in halls moved to a safe area?
  • Question 6: Were halls, corridors, and exit routes clear of obstructions?
  • Question 7: Were all corridor doors closed?
  • Question 8: Short-answer identifying who responded and what equipment they brought.
  • Question 9: Did staff monitor the exits?
  • Question 10: Was the building evacuated?
  • Question 11: Did staff or the fire department extinguish any simulated fire?
  • Question 12: Who sounded the “all clear,” and at what time?
  • Question 13: Was the emergency plan executed correctly?
  • Question 14: Did staff carry out their assigned responsibilities?
  • Question 15: Checkboxes for whether staff in different areas heard the alarm, responded promptly, and followed procedures.

Any “No” answer needs an explanation in the Comments/Problems section at the bottom. Describe what went wrong specifically: a blocked corridor, an alarm that wasn’t audible in a far wing, a staff member who wasn’t sure where to go. Vague entries like “some issues” won’t satisfy an inspector and won’t help you fix anything before the next drill.2Texas Health and Human Services. Fire Drill Report

Sign and Date Every Form

The header area has lines for “Report Completed By,” the person’s title, the date of the drill, the time, and the shift. Fill in every line. An unsigned or undated form reads as incomplete during an inspection and may be treated as if the drill never happened.2Texas Health and Human Services. Fire Drill Report

What the Form Leaves Out

There’s no field on Form 4719 for the number of occupants present or for total evacuation time. The Texas Administrative Code, though, requires childcare centers to document “the date of the drill, time of the drill, and length of time for the evacuation or relocation to take place.”3Cornell Law Institute. 26 Texas Admin Code 746.5205 – Must I Practice My Emergency Preparedness Plans Record the evacuation time and a headcount in the Comments/Problems section or on an attached sheet so you meet both the form’s requirements and the regulation’s.

How Often You Have to Drill

Under 26 TAC §746.5205, childcare centers must run a fire drill every month, and children must be able to safely exit the building within three minutes.3Cornell Law Institute. 26 Texas Admin Code 746.5205 – Must I Practice My Emergency Preparedness Plans If your evacuations consistently take longer, something in your layout, staffing, or procedures needs to change, and the Comments/Problems section is where you document the issue and your plan to fix it.

Residential child-care operations under 26 TAC Chapter 550 have an added requirement: drills must happen at varied times of day, so staff on every shift practice evacuating the building rather than only the morning crew.

How the Form Ties to Your Emergency Plan

Form 4719 documents the execution of your facility’s written emergency preparedness plan, which 26 TAC §746.5202 requires every childcare center to maintain. That plan must include written procedures for evacuating children (with specific provisions for infants and children with limited mobility), communicating with parents and local authorities, accounting for every child at the rally point, and reunifying children with their families once the emergency is lifted.4Cornell Law Institute. 26 Texas Admin Code 746.5202 – What Must My Emergency Preparedness Plan Include

When Question 13 asks whether the emergency plan was executed correctly, the inspector is checking whether the drill actually tested that written plan, not just whether everyone walked outside in an orderly line. If your plan says one staff member grabs the emergency contact binder, another sweeps the bathrooms, and a third leads children to the rally point, your post-drill evaluation should reflect whether each of those steps happened.

Keeping Completed Forms on File

Printed at the top of the form itself: “Keep this completed form in the facility and present it to the surveyor at the time of the inspection.”2Texas Health and Human Services. Fire Drill Report Under 26 TAC §746.803, childcare centers must retain required records on-site for at least three months from the date the record was created, unless a longer period is specified elsewhere in the chapter.5Texas Health and Human Services. Minimum Standards for Child-Care Centers Three months is the regulatory floor. Many administrators keep a full year’s worth of completed forms available, since inspectors check whether the number of reports matches the required monthly frequency.

Store the forms in a dedicated safety binder or a secure digital folder that any authorized staff member can access quickly. Unannounced licensing inspections are standard, and HHSC Child Care Regulation staff document any noncompliance with statutes, rules, or minimum standards as deficiencies; a cited deficiency identifies the specific rule violated and sets a reasonable compliance date.6Texas Health and Human Services. 4100, Inspecting Child-Care Operations Missing fire drill reports, incomplete forms, and skipped months all fit that pattern.

Tips for Drills That Produce Clean Reports

Running the drill is the easy part. Running it so the resulting Form 4719 holds up under inspection takes a bit more thought.

  • Vary the scenario every month. Rotate the simulated fire location, exit routes, and time of day. A kitchen fire during nap time tests different skills than a laundry fire during outdoor play, and the pre-drill checkboxes are designed for that variety.
  • Assign staff roles before the drill. Your emergency preparedness plan should already designate who sweeps rooms, who leads children to the rally point, who grabs the emergency binder, and who calls the fire department. Make sure each person knows their role before the alarm sounds.
  • Time the evacuation. Use a stopwatch and write the time in the Comments/Problems section. If you’re consistently under three minutes, that’s evidence of a well-drilled operation. If you’re not, you know where to focus.
  • Write honest Comments/Problems entries. A form that says “no problems” every month for two years doesn’t look thorough; it looks like nobody is paying attention. Real drills surface real issues: a door that sticks, a child who panics, an alarm that’s hard to hear in the far classroom. Document them, and note what you did in response.
  • Don’t backfill missed drills. Completing a stack of forms after the fact to cover a gap is the kind of thing inspectors are trained to spot. Clustered dates, identical handwriting across months, and forms with no meaningful variation all raise flags.