Appendix D: Interim Life Safety Measures (ILSM) Closeout Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Are egress routes and exits clear & unconstructed?

  Yes

  No

  N/A

• Are all exit signs operational and installed as designed?

  Yes

  No

  N/A

• Are all temporary signs removed?

  Yes

  No

  N/A

• Is access to emergency services restored?

  Yes

  No

  N/A

• If the fire alarm, detection and/or fire suppression system has been modified or new system installed has it been tested?

  Yes

  No

  N/A

• Is the area equipped with the appropriate number of fire extinguishers?

  Yes

  No

  N/A

• Is the area free of all construction materials and equipment?

  Yes

  No

  N/A

• Are all emergency evacuation signs installed and updated?

  Yes

  No

  N/A

• Are all ceiling tiles installed?

  Yes

  No

  N/A

• Has housekeeping completed the final cleaning of the area?

  Yes

  No

  N/A

• If any, Have all other safety related hazards or conditions in the area been addressed?

  Yes

  No

  N/A

• Other hazards to be noted?

  Yes

  No

  N/A

Signatures

• Safety and Security

  Sign

• Project Coordinator

  Sign

• Department Director

  Sign

• Contractor Representative

  Sign