FACILITY CONDITION SURVEY

• Conducted on

  Date

• Prepared by

• Location
  Address

• INSTRUCTIONS: Those assigned to conduct this survey should do so along with the facility users responsible for of elders. The companion document Life-Cycle Analysis (DC-97) form should be completed in conjunction with this survey

• The completed DC–96 and DC–97 documents should be sent to the Local Design/Construction Department (LDC)

  Yes

  No

  N/A

• WHQ Number:

• Survey Date:

  Date

PROPERTY DESCRIPTION

• Address:

Primary Use:

• Evaluated By:

FACILITY

• 1. Briefly describe the number and size of buildings and property being maintained

• 2. Are there any aspects of the facility that are maintenance intensive? If so, please describe

  Yes

  No

  N/A

• 3. What is the overall condition of the site and facilities?

  Yes

  No

  N/A

• 4. Are the facilities and property being effectively utilized for the intended theocratic purpose?

  Yes

  No

  N/A

MAINTENANCE PROGRAM

• 5. Have all follow-up points from the previous survey been completed? If not, please explain

  Yes

  No

  N/A

• 6. Are preventative maintenance tasks and safety maintenance program? If not, please explain

  Yes

  No

  N/A

• 7. Are efforts being made to use and train local volunteers to support the program?

  Yes

  No

  N/A

GENERAL OBSERVATIONS

• 9. Has available facility oversight reviewed this survey please explain

  Yes

  No

  N/A

• 10. Has a record been kept locally of replacements and noted on the DC-97?

  Yes

  No

  N/A

• OTHER

  Yes

  No

  N/A

• 11. Are property ownership documents in order?

  Yes

  No

  N/A

• 12. Are all property usage permits current?

  Yes

  No

  N/A

• DC-96-E 9/15

  Yes

  No

  N/A

SAFETY CHECKLIST

Fire Safety

•  Are fire extinguishers located at main exits and all other places required by law, and tagged with annual proof of service

  Yes

  No

  N/A

•  Are fire hose or sprinkler systems in good working condition?

  Yes

  No

  N/A

•  Are smoke alarms fully functional?

  Yes

  No

  N/A

•  Do dwelling-unit kitchens have smoke detectors? Have ovens, hoods, ducts, and filters been cleaned of grease and dirt?

  Yes

  No

  N/A

•  Has the emergency lighting been tested and found to be working?

  Yes

  No

  N/A

•  Are all exits free of obstructions and marked with properly illuminated signs?

  Yes

  No

  N/A

•  Do exit doors operate easily with panic hardware (if required) that is never disconnected when the building is occupied?

  Yes

  No

  N/A

•  Is the storage of flammable paints or liquids kept to a minimum and in sealed metal containers? Confirm that no

  Yes

  No

  N/A

• flammable cleaning fluids are being used or stored

  Yes

  No

  N/A

•  Are electrical closets, mechanical rooms, and the attic free of combustible materials including gas-powered tools or

  Yes

  No

  N/A

• equipment?

  Yes

  No

  N/A

•  Are heating flues properly isolated from combustible materials and regularly serviced by competent personnel?

  Yes

  No

  N/A

•  Have the boiler or hot-water heater been inspected by a licensed inspector, if legally required, and found to be safe?

  Yes

  No

  N/A

•  Is a valid Certificate of Occupancy and/or Place of Public Assembly permit (if required) posted?

  Yes

  No

  N/A

Slip/Trip and Fall Prevention

•  Do stairs and ramps have anti-slip surfaces? Are handrails provided and securely fastened?

  Yes

  No

  N/A

•  Are glass doors, sidelights, and full-length windows shatterproof or of safety glass material?

  Yes

  No

  N/A

•  Are mops and “wet floor” signs on hand to care for spills or water brought in by footwear, for cleaning bathrooms, and

  Yes

  No

  N/A

• other hard floor surfaces?

  Yes

  No

  N/A

•  Are entry floor mats in good condition without curled-up edges and fixed in a position so as not to slide around?

  Yes

  No

  N/A

•  Are outside walking areas (e.g., parking lot, sidewalks) in good condition and free of holes or tripping hazards?

  Yes

  No

  N/A

•  Are uneven surfaces (e.g., steps near doors or sidewalks) marked with contrasting colors or another method of warning

  Yes

  No

  N/A

• pedestrians of the danger of falling?

  Yes

  No

  N/A

•  Is the exterior lighting adequate in all walking areas, including the parking lot?

  Yes

  No

  N/A

•  Are supplies and proper equipment on hand to keep walkways and parking areas free of ice and snow in cold weather?

  Yes

  No

  N/A

General Loss Prevention

•  Are cleaning compounds and other hazardous chemicals safely stored out of reach of young children?

  Yes

  No

  N/A

•  Are the entire grounds free of holes, wires, or other hazards that could cause injury, even to uninvited visitors after dark?

  Yes

  No

  N/A

•  Are roofs, roof drains, and gutters in good repair and cleaned so they function properly, with no signs of leaks?

  Yes

  No

  N/A

•  Are basements, interior surfaces of exterior walls, ceilings, bathrooms, and other areas where moisture could accumulate

  Yes

  No

  N/A

• and cause damage, free of any signs of moisture problems?

  Yes

  No

  N/A

•  Has an annual termite inspection been performed? (Not necessary if there are no structural wood components.)

  Yes

  No

  N/A

•  Have carbon monoxide and radon alarms been checked and function properly? (If required in the building or dwelling unit.)

  Yes

  No

  N/A

FOLLOW-UP POINTS

• Please specify who is to follow on each point. Add lines as needed

• Item

• Issue

  Yes

  No

  N/A

• Recommended solution

User

• LDC

  Yes

  No

  N/A

• DC-96-E 9/15

  Yes

  No

  N/A