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

• Audit Title

• Permit No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

EXITS

• Are egress routes and exits clear & unconstructed?

  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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• If means of egress is changed, have evacuation routes been posted?

  Yes

  No

  N/A

EDUCATION/TRAINING

• Are 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 of the 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

COMPARTMENTATION FEATURES

• Are penetrations and/or openings protected in smoke or fire barrier within the area?

  Yes

  No

  N/A

• Are door latches operational?

  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

• 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

• Other hazards to be noted?

  Yes

  No

  N/A