Information
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Conducted on
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Business Name
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Add location
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Indicate which levels are approved by selecting the appropriate choice:
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Main Level
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Second Level
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Basement
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Indicate the date you began day care services at this location.
Contacts
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Provider Info - (Name, Phone Number and Email )
Required Information
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Child care provider is in a structure designed and/or used as one or two family dwelling. Day care center requirements must apply if in an apartment, church, commercial building or other area.
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Child care is on main level and has two remote compliant exits. (Secondary exit may be stairs, a compliant rescue/ventilation window or door leading directly to the outside)
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Child care is in the basement area and has compliant exiting. (Secondary exit may be a compliant stairs leading to the main level, compliant rescue/ventilation window or door leading directly to the outside. If window is used, all new IHDCs after 5/1/14 shall be equipped with inter-connected smoke alarms. Hard-wired or wireless smoke alarms may be used.)
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Child care is on the second floor and has compliant exiting. (Secondary exit may be a compliant stairs leading to the main level, a compliant rescue/ventilation window or door leading directly to the outside. If window is used, all new IHDCs after 5/1/14 shall be equipped with inter-connected smoke alarms. Hard-wired or wireless smoke alarms may be used.)
Fire Prevention
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Primary or secondary means of escape does not exit through any hazard area. (Garage, storage, etc)
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Every required exit door can be easily opened from the inside at all times when the facility is operating.
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Every escape path, including all stairways, is clear of obstacles and all doors are in proper working order.
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Working smoke alarms are located in every pathway and sleeping room used for child care.
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Single-station smoke alarms, hard wired to the electrical system with battery backup or battery smoke alarms where battery is replaced at least annually. Smoke alarms shall be less than 10 years old.
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Smoke alarms are tested monthly and records are kept on file for review.
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Homes with gas-fueled appliances shall have a carbon monoxide alarm. Alarms can be powered by home electrical system or battery powered where battery is replaced at least annually.
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Copy of the current FIRE/LIFE SAFETY AGREEMENT is posted next to license.
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Children can open every closet door from the inside at all times.
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Written emergency procedures for fire evacuation are provided and practiced monthly.
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Monthly fire drills are documented. Drills shall be conducted and evacuation times shall be within 4 minutes. Inspector may ask the provider to demonstrate ability to conduct such a fire drill in his/her presence.
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Written emergency procedures for tornados are provided and practiced April through September.
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Every bathroom door can be easily opened from the outside at all times. The unlocking key/device is readily available to the provider.
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All unused electrical outlets (in license area) have child-resistant protective covers.
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All fuel-fired heaters are properly vented to the outside.
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A barrier that prevents children from getting too close or burned protects all heating devices.
Other violations that need to be addressed
Conclusion
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Violations to be corrected by:
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Inspector (Name and Email)
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ANNUAL RENEWAL: I declare the the Fire and Life Safety Agreement has been examined by me and to the best of my knowledge and belief is a true, correct and complete attestation of my compliance with fire codes as required by Kansas law. I understand that failure to comply with Kansas fire codes may result in fines or a cease and desist order pursuant to KSA 31-139 and KSA 31-159.
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If you agree with the statement above, please check the box, sign your name and provide the date that you reviewed the agreement.
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I have read and understand the above declaration.
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Person receiving report
