Facilities Inspection Form

FACILITY FIRE PREVENTION AND EMERGENCY PREPAREDNESS INSPECTION CHECKLIST
Date of Inspection: ___________ Conducted by: ________________ ___________________________________________ Reviewed by: _____________________________________ Date of Review: ______________________________________________ Comments or additional corrective action taken as a result of the review: ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ For each checklist item: If the item inspected is satisfactory, check the OK box If a deficiency is identified, complete the Comments section and indicate the Action Taken If the item does not apply, check the N/A box Imminent Hazards: If a serious hazard is encountered which cannot be immediately abated without endangering employees and/or property, contact your supervisor or facilities manager immediately. All exposed employees should be removed from the area or protected until the hazard is corrected. Many of the inspection points are based upon various National Fire Protection Association (NFPA) standards that may apply to facilities and operations of the organizations. The purpose of the NFPA Code is to prescribe minimum requirements necessary to establish a reasonable level of fire safety and property protection from the hazards created by fire and explosion. This checklist does not include all potential hazards. During your inspection, look for all unsafe conditions or potential hazards. Use the Other Observations and Additional Comments section (end of checklist) to record your observations. This report and recommendations are purely advisory and for the purpose of assisting with fire and loss prevention procedures. Observations and recommendations are the result of practices and conditions observed and information made available at the time of the inspection and do not purport to refer to or guarantee compliance with local, state or federal regulations which may be applicable to such practice and conditions. This report should not be considered a definitive listing of all existing hazards nor an absolute solution to all indicated hazards. Implementation, management and operation of risk control and safety procedures are the responsibility of the organization. Location:
Fire Prevention - All Facilities

Fire extinguishers inspected monthly and serviced by contractor annually Portable space heaters have automatic shut off feature if tipped over Personal electric appliances inspected for safety before being used in workplace Emergency telephone number posted in clear and conspicuous locations Extension cords are used minimally and are temporary Flammable or combustible liquids not stored in building Trash is removed at least daily from building Fire and smoke detection systems inspected and serviced Building exterior is free of trash and combustible debris
OK
N/A
Comments
Action Taken
Fire Prevention - Buildings with Automatic Sprinkler Systems

Sprinkler control valves are secured in open position Fire department connections are capped and secured Spare sprinkler heads and tools are readily available and accessible Sprinkler heads are at least 18 above stored material Main drain flow test is performed on system annually Inspectors test valve is opened at least every 2 years Gauges are inspected and operating properly as applicable Alarm device is operating and sounds to responding authority when activated
OK
N/A
Comments
Action Taken
Building Utilities
Electric circuit breaker panels kept clear at least 36 in front of panel All circuit breakers in panel are identified to show which circuits they power Electric panels are accessible by trained and authorized personnel Gas main feed identified, kept clear of debris and protected from physical damage Gas main shut off tools readily available and authorized person trained to use tools
OK
N/A
Comments
Action Taken
Emergency and Standby Power Systems (ESPS)

ESPS exercised at least once monthly by trained and authorized personnel, recorded in log Transfer switches operated monthly by authorized personnel, recorded in log Main & feed breakers are exercised annually Emergency power set has at least 2 sets of instructions manuals Special tools and testing devices for ESPS are available to trained and authorized personnel Replacement parts for high mortality items are readily available Written maintenance and operational testing program established and documented Transfer switches are included in maintenance program Storage batteries inspected at intervals not more than 7 days
OK
N/A
Comments
Action Taken
Record File Room - Fire Protection

Vital records are not stored in file room Walls have no openings other than necessary for access File room door has fire rating equiv. to that of walls Door has closing device connected to smoke sensors File room has no pendant lamps or extension cords All records kept in cabinets are at least 3 above floor Fire extinguisher kept outside door of file room File room is not used as a working space
OK
N/A
Comments
Action Taken
Record Storage Vaults Fire Protection

Vault wall penetrations are small and sealed Vault door has fire resistance rating equivalent to vault walls Vault has no pendant lamps or extension cords Records kept in fully enclosed non-combustible containers All records kept in cabinets are at least 3 above floor Before closing vault, all record containers are closed Before closing vault, all paper waste is removed Vault is not used as a working space Records are kept at least 18 below sprinkler deflectors
OK
N/A
Comments
Action Taken
Fire extinguisher kept outside door of vault
Computer Room Fire Protection

Access is restricted to only persons absolutely necessary to operation of equipment Written emergency fire plan prepared and posted inside and near computer room Computer room not located above/below hazardous areas Structural supports and raised floor decks noncombustible Deck access tools to remove panels are in room and well marked Under-floor cable openings provided with fire stops of approved sealant Office tables and desks in room are metal construction Only self-extinguishing trash receptacles used in room Only records essential to computer operations are kept in computer room Records storage rooms are separate from computer room Paper stock and other media restricted to absolute minimum Automatic smoke and fire detection system annunciate at constantly attended location Fire extinguishers indicate the type of fire for which it is intended Gaseous total flooding system serviced and tested as recommended by installer Changes to computer room configuration approved by detection and extinguishing system installer Steam, water or drain piping should not be in place over computer room
OK
N/A
Comments
Action Taken
Equipment and Vehicle Storage Facilities

When liquefied natural gas fueled vehicles are repaired or stored, open flame heaters are not permitted Suspended heaters are not less than 8 ft. above floor Flammable spray painting not conducted near open flame or spark producing devices Parts cleaning solvent is non flammable or no ignition source in the area Fuel tanks drained and purged or inerted prior to work Combustible rubbish placed in covered metal receptacles and removed daily Oily rags kept in metal container with self closing cover Fire extinguishers are adequate for exposure and in clear and conspicuous places
OK
N/A
Comments
Action Taken
Storage of Flammable Materials

Flammable gasses stored at least 20 from oxygen gas Open flames not permitted in flammable storage areas Liquified flammable gas cylinders stored upright or that pressure relief valve in direct contact with vapor space Approved storage cabinet used for flammable liquid storage
OK
N/A
Comments
Action Taken
Emergency Action Plans

Emergency escape procedures and emergency route assignments are written and posted Procedures established for designated employees who may operated critical operations before they evacuate Procedures established to account for all employees after emergency evacuation has been completed Rescue and medical duties established for those employees who are to perform them Emergency reporting procedures and emergency notification telephone numbers established and posted Names or job titles or departments who can be contacted for further information or explanation of duties under emergency action plan Training has been provided for a sufficient number of persons to assist with emergency evacuation Review conducted with each employee upon initial assignment regarding emergency action plan
OK
N/A
Comments
Action Taken
Emergency Preparedness
Location of emergency supplies and materials, 1 aid kits have been identified and inspected Heavy objects are placed below 42 to avoid them falling on person during earthquake Racks, shelves, and cabinets are secured from tipping during earthquake Evacuation practice drills are conducted as necessary Emergency egress route kept clear and exits have been identified Emergency evacuation plan for people with disabilities established and communicated
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OK
N/A
Comments
Action Taken

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What are the main inspection points covered in the checklist?

What precautions are outlined for computer rooms?

FACILITY FIRE PREVENTION AND EMERGENCY PREPAREDNESS INSPECTION CHECKLIST

Fire Prevention - All Facilities

Fire Prevention - Buildings with Automatic Sprinkler Systems

Emergency and Standby Power Systems (ESPS)

Record File Room - Fire Protection

Record Storage Vaults Fire Protection

Fire extinguisher kept outside door of vault

Computer Room Fire Protection

Equipment and Vehicle Storage Facilities

Storage of Flammable Materials

Emergency Action Plans

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