Appendix B: Interim Life Safety Measures (ILSM) Inspection Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

EXITS

• Are egress routes and exits clear & unconstructed? If YES, skip to item 2.

  Yes

  No

  N/A

• If exits are obstructed, have alternate exits been established?

  Yes

  No

  N/A

• If alternate exits have been established, are personnel in the area informed and aware of there relocation and existence?

  Yes

  No

  N/A

• Are all exits clearly identified and visible in the event of an emergency?

  Yes

  No

  N/A

• Are evacuation routes posted?

  Yes

  No

  N/A

EDUCATION/TRAINING

• Are written procedures and guidelines posted in the immediate area for what to do and who to call in the event of a fire or emergency?

  Yes

  No

  N/A

• Are personnel in the immediate area aware and informed regarding procedures to follow in the event of fire of emergency?

  Yes

  No

  N/A

FIRE ALARM, DETECTION AND SUPPRESSION FEATURES

• Is the fire alarm system operational?

  Yes

  No

  N/A

• Is the fire sprinkler system operational?

  Yes

  No

  N/A

• If the existing fire alarm or sprinkler system is impaired, have measures been taken to provide equivalent systems for adequate protection?

  Yes

  No

  N/A

• Are the temporary fire alarm or sprinkler systems being inspected and tested monthly?

  Yes

  No

  N/A

• Are personnel in the area aware and informed on how to use the temporary fire alarm and or sprinkler system?

  Yes

  No

  N/A

COMPARTMENTATION FEATURES

• Are there unprotected penetrations and/or openings in any smoke or fire barrier?

  Yes

  No

  N/A

• Is there a penetration permit for the unprotected penetrations and/or openings?

  Yes

  No

  N/A

• Are there any door latching problems?

  Yes

  No

  N/A

• Are self closing devices operational?

  Yes

  No

  N/A

• Are fire and/or smoke dampers operational?

  Yes

  No

  N/A

MISCELLANEOUS

• Are temporary construction partitions smoke tight and non combustible?

  Yes

  No

  N/A

• Are storage, waste and debris areas being maintained to minimize potential for fire or safety hazards?

  Yes

  No

  N/A

• Are portable fire extingquishers (fully charged w/ current inspection stickers) readily available?

  Yes

  No

  N/A

• If there is hot work, do workers have hot work permit?

  Yes

  No

  N/A

• Do electrical panels, temporary wiring, extension cords, tools and equipment appear to be installed, utilized and functioning Ina safe manner?

  Yes

  No

  N/A

• In general, are the exterior construction site, building and grounds free of hazards and potential safety violations?

  Yes

  No

  N/A

• Are hand and safety rails in place and maintained in good condition?

  Yes

  No

  N/A

• Are MSDS readily available for any hazardous chemicals that are present or being used?

  Yes

  No

  N/A

• Do ladders and scaffolds appear to be in satisfactory condition and used in a safe manner?

  Yes

  No

  N/A

• If required, is personal protective equipment (PPE) being used?

  Yes

  No

  N/A

• If electrical equipment needs to be deenergized, are applicable lockout/tagout procedures being followed?

  Yes

  No

  N/A

• Other hazards to be noted?

  Yes

  No

  N/A