RISK MANAGEMENT

QUARTERLY BUILDING REPORT

Fire Safety Self -Inspection Checklist

Quarter: Year
Fall ______ Building: ________________ Phone:_______________________
Winter ______
Spring ______ Safety Coordinator: ___________________ Date: _____________
Summer ______

Use the Checklist to conduct your own fire inspections in-between your annual Fire inspections.
1. If your answer is “Not Ok” Please file a work with Physical Plant at [email protected] and specify the “location” where the correction is
needed.
2. Complete and return this form to the Office of Risk Management.
NOT
Fire Protection Equipment OK OK Location
Fire extinguishers are fully charged and tagged.
*(it is charged if the yellow arrow in the pressure gauge is in the green area)
Fire extinguishers are accessible
Cabinet door is operable; extinguisher mounted at least 4” off
floor to not more than 5 feet top of extinguisher.
Fire extinguishers tags are current (serviced with last 12 months)
*(the tag expires one year from date of inspection)
Fire Sprinklers/detectors are free from obstruction

Sprinkler Heads: Storage is maintained 18”below

Sprinklers in need of replacement (damaged, corroded, painted)

Fire Hoses (@ Sierra Towers)—

When standpipe stations are enclosed in locked cabinets, and
doors are equipped with approved visual identification clear glass
panels, are glass panes easily broken?
Is the door capable of being opened when the glass panel is
broken? Is the unlocking handle painted red?
Is the direction the handled must be pushed or pulled indicated
to open the door? Is the door labeled Fire equipment-in case of
fire, break glass and operate red handle?
Is the hose system inspected at least annually and after each
use to assure that all the equipment and hoses are in place,
available for use, and in serviceable condition? [29 CFR
1910.158(e)(2)(iii)]
Is hemp or linen hose on existing systems un-racked,
physically inspected for deterioration, and re-racked using a
different fold pattern at least annually? [29 CFR 1910.158(e)(2)(v)]
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 Exterior, Interior and Environment OK NOT Location
OK
All exits, stairwells, emergency exits and fire escapes are free
from stored materials that may impede evacuation.
Emergency Exit signs are clear and illuminated in proper
working condition.
Emergency lights are tested monthly (push button to test)
Automatic fire doors open properly. *(Palmer Hall)
The building is free of all other fire hazards.
Corridors-Storage of any kind, regardless of corridor width, is not
permitted unless specifically permitted by regulations or in writing by
the Riverside Fire Department.
Agreements must be renewed every 5 years.

Exit and Corridor Doors-Must open and close and latch properly.
Must not be blocked, propped open or rendered inoperable unless
specifically permitted in writing by the Riverside Fire Department.
Agreements must be renewed every 5 years.

NOT
Electrical OK OK Location
Extension or phone cords are not stored on the floors.
Combustible materials are not stored near an electrical switch
gear or a space heater.
Electrical outlets are not exposed.
Dried out extension cords or “octopus” outlets are not used.
Electrical plates are not missing or cracked.
Light switches are not loose or weak.
Outlets are not cracked or plugged.
Plugs do not fall out of the outlet easily.
The building is free of all other electrical hazards.
Any outlets within 5 feet of a sink or drinking fountain are
equipped with a GFI. (If not, specify the location and place a work order
with Physical Plant)
A three foot working space is maintained in front of all electrical
panels.
No exposed wiring

Portable electric space heaters in offices are not allowed per the
Fire Code.

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 NOT
Housekeeping and Storage OK OK Location
Emergency Management Preparedness:
55 Gallon Drums of Water locations see below:
Water to be rotated every 6 months by Physical Plant. Add 1 cup
of bleach to water for mold resistance—
Angwin- 1 Drum Laundry Rooms 319 and 1 Drum 375
Calkins- 1 Drum Laundry Room 151 and 1 Drum Shower Room 208
Admin- 1 Drum Kitchen Room 121
Market- 2 Drums in Emergency Storage 2nd Floor
South Hall- 1 Drum Kitchen/Laundry Room
Gladwyn Hall- 1 Drum Laundry Room
Hole Memorial- 1 Drum Next to Room 139
VAC- 1 Drum Room 111
Library- 1 Drum Media Services Room
Sierra Towers- 3 Drums in cage beneath emergency stairway

Aisles in the work areas are not blocked by storage items or

trash.
Storage areas are kept clean and orderly; cleaning materials are
safely stored.
Combustible materials are not kept in unprotected areas, such as
a crawl space.
Trash is not left to accumulate in excessive quantities; trash
receptacles are emptied regularly.
Floor tiles are not broken, cracked, loose, or missing.
Carpet seems are not split
The carpet does not have loose edges.
Materials that could fall are not stored on top of file or storage
cabinets.
Windows are not broken or cracked.
Floors are not slick.
NOT
Shops / Laboratories / Packing Areas OK OK Location
Laboratory wastes are disposed of daily, with the use of
appropriate precautions.
Electrical equipment in areas near where flammable liquids are in
use is explosion proof.
Electrical appliances have warning lights and are unplugged when
not in use.
Employees are aware of special hazards and trained in any special
precautions necessary.
Entry is limited to authorized persons.
Woodworking equipment dust collectors are functioning
adequately, and collector bins are emptied regularly.
Power tools are unplugged when not in use.

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 NOT
Hazardous Materials OK OK Location
Emergency measures are posted in case of accidental spills.

Flammable/combustible liquids are kept in approved safety

containers.

Flammable/combustible liquids are stored in an approved

cabinet.

Safety storage cabinet vents are clear of obstructions.

Soiled rags are kept in an approved self-closing waste

container.
Portable fire extinguishers are in their place and of the proper
type.

Emergency measures are posted in case of accidental spills

Physical Plant / Palmer Hall / PSC / Art
Compressed Gas Cylinders-Must be secured with chains or other
approved method.

Flammable/Combustible Liquids-Must have less than 10 Gallons in

any single laboratory/room, in use at any one time unless specifically
permitted in writing by the Fire Department. Agreements must be
renewed every 5 years.

Storage-In original shipping containers or approved safety containers

(maximum 5 gallons). Total aggregate of materials in safety containers
must not exceed 25 gallons.

Quantities in excess of 10 gallons and not in safety containers, or

greater than 25 gallons in safety containers, must be stored in a
Flammable Liquid Storage Cabinet.

Dispensing-Dispensing from containers exceeding 5 gallons is not

permitted unless using a listed pump in accordance with California Fire
Code requirements. Annual permit must be obtained from Fire
Department.

NOT
Exhibits / Collections / Book Stacks OK OK Location
Exhibits and collections are not overcrowded.
Exhibit case lights do not show signs of overheating.
Exhibits are not blocking exit routes and/or access to fire
protection equipment.
Extension cords are not used.
All vertical/horizontal openings in fire barriers are fire-stopped.
Salvage equipment and materials are provided and accessible.
Created by the Office of Risk Management & ADA
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The fire department is familiar with and has access to these areas.
Smoking regulations are enforced with employees and visitors.

NOT
Auditoriums and Classrooms OK OK Location
Safe capacity is posted and enforced.
Standing and sitting in aisles is prohibited.
Smoking regulations are enforced
NOT
Commons and Eating Areas OK OK Location
Safe capacity is posted and enforced.
Aisles and exit routes are unobstructed and illuminated.
Ranges, hoods, and exhaust ducts are clean.
NOT
Equipment OK OK Location
Desks or chairs are in good working condition.
Desks and file cabinet drawers are closed to prevent tripping.
The building is free of all other equipment hazards.
NOT
Miscellaneous OK OK Location
Change in occupancy or use. Changes in how a room or area is
used must be reviewed by the Fire Department. Examples
include office to laboratory; office to meeting room; classroom
to laboratory; etc.

Construction-Modifications to buildings, rooms or areas need to

be reviewed by the Fire Department. Examples include
removal/addition of walls; blocking of doors; adding rooms,
etc.

Aesthetic modifications, which involve painting, etc., do not

need review by the Fire Department, but may need coordination
to prevent accidental activation of smoke detectors.

Use of candles is not allowed.

NOT
Parking Lots/Grounds OK OK Location
There are no tripping hazards on the sidewalks, lawn and parking
lot.
The parking lot is adequately marked and lighted at night.
The parking lot/grounds are free of all other hazards.

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 Complete Building inspection report at the end of every quarter.
Send the completed form to LSU Risk Management

FIRE EXTINGUISHER
ANNUAL MAINTENANCE CHECKLIST
In Accordance with NFPA 10: Must be performed by certified technicians

* CLEAN EXTINGUISHER
* VISUAL EXAMINATION - is performed on entire unit, carefully inspecting for signs of dents, rust,
corrosion, pitting or other shell damage
* CHECK PRESSURE GAUGE - to insure that the unit is in the proper range and that it is the proper gauge
* CHECK FOR TEST & MAINTENANCE DATES - to determine need for hydrostatic test, 6 year internal
maintenance or thorough shop check etc.
* WEIGH EXTINGUISHER - to insure correct amount of extinguishing agent
* REMOVE DISCHARGE HOSE / NOZZLE - to inspect for signs of blockage
* REMOVE PULL PIN - to insure that pin can be removed in the event of an actual fire emergency and install
new tamper seal
* CHECK HANDLE / LEVER - to insure smooth operation (not bent)
* CHECK MOUNTING BRACKET - to insure that unit is mounted securely and with the proper bracket
* INSTALL OR RE-INSTALL UNITS - to ensure proper, permanent location of unit
* CHECK HAZARD APPLICATION - to be sure that the fire extinguisher is the proper one for the potential
fire hazard
* RETURN EXTINGUISHER TO PROPER LOCATION
* ATTACH SERVICE TAG - filled out with all the proper information
* RECORD ALL INFORMATION ON DATA SHEETS

MONTHLY INSPECTION CHECKLIST

In Accordance with NFPA 10: Must be performed by owner or designated employee

* FIRE EXTINGUISHER LOCATED IN DESIGNATED PLACE

* NO OBSTRUCTION TO ACCESS OR VISIBILITY OF FIRE EXTINGUISHER
* PRESSURE GAUGE READING IN THE OPERABLE RANGE OR POSITION
* FULLNESS DETERMINED BY WEIGHING OR LIFTING OF THE FIRE EXTINGUISHER
* CONDITION OF THE FIRE EXTINGUISHER HOSE OR NOZZLE
(Inspections must be recorded on tag or label attached to the fire extinguisher)

Annual Service
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Annual service is intended to give maximum assurance that the extinguisher will operate safely and effectively.
It includes all points covered in our inspection, and any necessary repair, replacement and/or subsequent
testing. A tag or label is securely fastened identifying the individual having performed the service.

6-Year Maintenance
Every 6 years, stored pressure extinguishers must be emptied and subjected to a full internal inspection and
applicable maintenance procedures, including a thorough examination of all mechanical parts, extinguishing
agent and expellant.

Hydrostatic Testing
A periodic test mandated by NFPA and the Department of Transportation (DOT) requiring highly specialized
test equipment to ensure the integrity of an extinguisher or cylinder at its listed operating pressure. Dry
chemical, Halotron, and other clean agent extinguishers are to be hydro tested at 12 year intervals. High
pressure carbon dioxide extinguishers are to be tested at 5 year intervals.

Fire Hose Maintenance

All in service hose designed for occupant use shall be removed and tested at intervals not exceeding 5 years
after installation and every 3 years thereafter.

FIRE HOSE MAINTENANCE CHECKLIST

In Accordance with NFPA 1962:

* YEARLY VISUAL INSPECTION ON HOSE - is performed. making sure that the hose is properly hung in
place
* VISUALLY INSPECT STANDPIPE VALVE for any sign of leakage or damage, and advise customer
* VISUALLY INSPECT NOZZLE - making certain that nozzles are in the closed position, inspect for cracks
and visible signs of damage
* VISUALLY INSPECT RACK AND HANGERS - for any bent or broken racks or pins
* CHECK FOR TEST AND MAINTENANCE DATES - to determine need for hydrostatic test or other
maintenance
* HYDROSTATIC TEST - when required, includes the following:
- un-rack and remove hose
- place loaner hose
- hydrostatic test of hose, according to CODE requirements
- place hydrostatic test label based on pass and test procedures
- document test procedures
- refold fire hose to proper cabinet or rack specifications
- return and re-rack hose
- advise customer of deficiencies and take corrective action where required

Created by the Office of Risk Management & ADA

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