Title Page

  • Conducted on

  • Prepared by

  • Location
  • Please select location. If location isn't listed, please select NOT LISTED and enter the ORFAC and Location name in the box below.

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Instructions

  • 1. Include photos of each of the areas requested below. Also, be sure to take one photo that will go on the front cover of the report. 2. Include a photo of each area in need of repair. 3. All items that rate “poor” or “immediate attention required” must have a narrative explaining the reason for the poor condition. 4. Please be sure to described in the comment section the location of key assets/components of the building that first responders after a hurricane related event will need to find in order to trouble shoot the condition of the property and determine needed repairs. Rate each item as follows: Satisfactory / Poor / Immediate Attention Required / N/A – Not Applicable

Exterior

Lighting/Electrical

  • Pole Lights Functioning?

  • Pole Lights Functioning Comments:

  • Pole Lights Appearance

  • Pole Lights Appearance Comments:

  • Soffit/Undercanopy Lights

  • Soffit/Undercanopy Lights Comments:

  • Wall Units

  • Wall Units Comments:

  • Ground Lights

  • Ground Lights Comments:

  • Other

  • Other Comments:

  • Lighting/Electrical Photos (please be sure to get photos of the major components)

Parking Lots/Sidewalks

  • Sidewalks

  • Sidewalks Comments:

  • Pavements

  • Pavements Comments:

  • Curbs

  • Curbs Comments:

  • Concrete dock apron

  • Concrete dock apron Comments:

  • Potholes Repairs Asphalt/Crack Filling and Sealing

  • Potholes Repairs Asphalt/Crack Filling and Sealing Comments:

  • Area Drains/Catch Basins

  • Area Drains/Catch Basins Comments:

  • Lot Striping

  • Lot Striping Comments:

  • Safety Rails

  • Safety Rails Comments:

  • Signage

  • Signage Comments:

  • Parking Lots/Sidewalks Photos (please be sure to get photos of the major components)

Landscaping

  • Irrigation/Drainage

  • Irrigation/Drainage Comments:

  • Beds

  • Beds Comments:

  • Trees

  • Trees Comments:

  • Shrubs

  • Shrubs Comments:

  • Flowers

  • Flowers Comments:

  • Litter

  • Litter Comments:

  • Lawn Areas

  • Lawn Areas Comments:

  • Flag Pole

  • Flag Pole Comments:

  • Grounds/Grass

  • Grounds/Grass Comments

  • Landscaping Photos (please be sure to get photos of the major components)

Roof

  • Gravel Stop

  • Gravel Stop Comments:

  • Coping

  • Coping Comments:

  • Flashings

  • Flashings Comments:

  • Roof Membrane

  • Roof Membrane Comments:

  • Stone Ballast Coverage

  • Stone Ballast Coverage Comments:

  • Drains

  • Drains Comments:

  • Gutters and Downspouts

  • Gutters and Downspouts Comments:

  • Debris/Litter

  • Debris/Litter Comments:

  • Access Hatch

  • Access Hatch Comments:

  • Vent Openings

  • Vent Openings Comments:

  • Chimney or Stack

  • Chimney or Stack Comments:

  • Penetrations

  • Penetrations Comments:

  • Pitch Pockets

  • Pitch Pockets Comments:

  • Scuppers

  • Scuppers Comments:

  • Surface Conditions

  • Surface Conditions Comments:

  • Signs of water intrusion

  • Signs of water intrusion Comments:

  • Miscellaneous

  • Miscellaneous Comments:

  • Roof Photos (please be sure to get photos of the major components)

HVAC

  • Location (roof, ground, other)

  • Location (roof, ground, other) Comments:

  • Equipment Curbs

  • Equipment Curbs Comments:

  • Power Feeds

  • Power Feeds Comments:

  • Condensate Drains

  • Condensate Drains Comments:

  • Access Panels

  • Access Panels Comments:

  • Exhaust Fans

  • Exhaust Fans Comments:

  • Other

  • Other Comments:

  • HVAC photos (please be sure to get photos of the major components)

Building Shell

  • Exterior Walls

  • Exterior Walls Comments:

  • Caulking/Expansion Joints

  • Caulking/Expansion joints Comments:

  • Painted Surfaces

  • Painted Surfaces Comments:

  • Storefronts/Glass/Caulk

  • Storefronts/Glass/Caulk Comments:

  • Hose Bibs

  • Hose Bibs Comments:

  • Foundation

  • Foundation Comments:

  • Doors/Paint/Stain

  • Doors/Paint/Stain Comments:

  • Door Frames

  • Door Frames Comments:

  • Windows & Frames

  • Windows & Frames Comments:

  • Signage

  • Signage Comments:

  • Overhangs

  • Overhangs Comments:

  • Exterior Building Lighting

  • Exterior Building Lighting Comments:

  • Cleanliness of Surface

  • Cleanliness of Surface Comments:

  • Signs of water intrusion

  • Signs of water intrusion Comments:

  • Soffit/Undercanopy Lights

  • Soffit/Undercanopy Lights Comments:

  • Building Shell photos (please be sure to get photos of the major components)

Truck Docks

  • Doors/Paint/Stain

  • Doors/Paint/Stain Comments:

  • Door Frames

  • Door Frames Comments:

  • Weather-striping

  • Weather-striping Comments:

  • Dock Seals

  • Dock Seals Comments:

  • Dock Levelers

  • Dock Levelers Comments:

  • Miscellaneous

  • Miscellaneous Comments:

  • Truck Dock Photos (please be sure to get photos of the major components)

Drive-In Doors

  • Door Panels/Paint/Stain

  • Door Panels/Paint/Stain Comments:

  • Door Frames

  • Door Frame Comments:

  • Weather-striping

  • Weather-striping Comments:

  • Miscellaneous

  • Miscellaneous Comments:

  • Drive-In Doors photos (please be sure to get photos of the major components)

Exterior Items

  • Trash Containers/Dumpsters

  • Trash Containers/Dumpsters Comments:

  • Handrails/Railings

  • Handrails/Railings Comments:

  • Steps/Ramps

  • Steps/Ramps Comments:

  • Perimeter Fence/Gates

  • Perimeter Fence/Gates Comments:

  • Miscellaneous

  • Miscellaneous Comments:

  • Exterior Items photos (please be sure to get photos of the major components)

Interior

Life Safety

  • Fire Department Knox Box

  • Fire Department Knox Box Comments:

  • Exit Signs

  • Exit Signs Comments:

  • Exit Doors

  • Exit Doors Comments:

  • Door Panic Hardware

  • Door Panic Hardware Comments:

  • Fire Extinguishers

  • Fire Extinguishers Comments:

  • Fire Hose Drops

  • Fire Hose Drops Comments:

  • Eye Wash

  • Eye Wash Comments:

  • Life Safety photos (please be sure to get photos of the major components)

Fire Suppression System

  • Alarm Panel

  • Alarm Panel Comments:

  • Pump Controller

  • Pump Controller Comments:

  • Risers/Valves/Flow Alarms

  • Risers/Valves/Flow Alarms Comments:

  • Inspectors Test Drains

  • inspectors Test Drains Comments:

  • Spare Sprinkler Heads

  • Spare Sprinkler Heads Comments:

  • Fire Pump Certification

  • Fire Pump Certification Comments:

  • Room Appearance

  • Room Appearance Comments:

  • Fire Suppression photos (please be sure to get photos of the major components)

Office/Clinic Area

  • Ceiling Tile

  • Ceiling Tile Comments:

  • Walls

  • Walls Comments:

  • Doors/Paint/Stain

  • Doors/Paint/Stain Comments:

  • Door Hardware/Frame

  • Door Hardware/Frame Comments:

  • Floor/Carpet/Tile

  • Floor/Carpet/Tile Comments:

  • Windows

  • Windows Comments:

  • Painted Surfaces

  • Painted Surfaces Comments:

  • Lighting

  • Lighting Comments:

  • Cleanliness

  • Cleanliness Comments:

  • Signs of water intrusion

  • Signs of water intrusion Comments:

  • Office/Clinic Area photos (please be sure to get photos of the major components)

Washrooms

  • Ceiling

  • Ceiling Comments:

  • Walls

  • Walls Comments:

  • Door/Paint/Stain

  • Door/Paint/Stain Comments

  • Door Hardware/Frame

  • Door Hardware/Frame Comments:

  • Floor Tile

  • Floor Tile Comments:

  • Plumbing Fixtures

  • Plumbing Fixtures Comments:

  • Light Fixtures

  • Light Fixtures Comments:

  • Painted Surfaces

  • Painted Surfaces Comments:

  • Cleanliness

  • Cleanliness Comments:

  • Washroom photos (please be sure get photos of the major components)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.