Title Page

  • Site conducted

  • Location
  • Conducted on

  • Prepared by

  • Recommending Agency/ Requesting Party

  • Recommending Agency Address
  • Name of Family/ Facility

  • Owner Name

  • Representative

  • Contact Phone Number

  • Facility Type

  • Other type of residential use

  • Building Code Reference

  • Explanation

Structure Information

  • Type of structure

  • Manufactured

  • Type of construction

  • Explanation

  • Type of floors

  • Explanation

  • Type of stairways

  • Explanation

  • Number of floors

  • Floors approved for sleeping arrangements

  • Limitations on sleeping arrangements

General Requirements

  • Two remote means of escape from each level where child care is provided.

  • Means of escape free from clutter and other obstructions.

  • Stairs, hallways, and passages to exit are adequately lighted.

  • No room used for children is reached only by ladder or trapdoor.

  • Child-proof covers are used on electrical receptacles.

  • Extension cords are used only as temporary wiring.

  • Flammable and combustible materials are properly stored

  • Floor plan is posted showing fire and emergency evacuation route from facility.

  • Record is kept of practice fire drills.

Foster and Adoptive Homes

  • A working U.L. approved smoke alarm on each level of occupancy of the home?

  • A U.L. approved portable fire extinguisher in working order in or near cooking area?

  • Unvented kerosene or oil heaters are not is use and evidence shows such?

Residential Facilities

  • Group Home, CRC or Crisis Care Facility

  • Are smoke detectors located according to instructions of the local fire inspector or state fire marshal?

  • Free standing wood burning stoves and unvented kerosene gas or oil heaters shall not be used. Is<br>there any evidence of usage?

  • Is the written calendar of periodic fire drills (developed by the agency) approved by fire inspector?

  • Is the evacuation plan approved?

Facility Specific Information

  • Is a fire alarm system provided

  • Type of alarm system

  • Explanation

  • Is the alarm system compliant

  • Is a fire suppression system provided

  • Type of suppression system

  • Is the suppression system compliant

Fire Safety Infraction(s)

  • Is the facility reasonably free from conditions hazardous to the safety of children and approved as such?

  • Explanation

  • Fire Safety Infraction(s)
  • Location of Infraction

  • Photo of Infraction

  • Infraction Description

  • Ohio Administrative Code Section

  • OFC Section

  • Recommended Remediation

  • Positive Observations
  • Photo of Positive Observation

  • Positive Observation Description


  • Inspection Notes

  • Report(s) Copies
  • Report(s) shall be sent to

  • Attachment(s)
  • Attachment

  • Was the inspection able to be completed

  • Why couldn't the inspection be completed

  • Re-inspection date

  • This home/facility is found to be in compliance and is approved.

  • The infractions found here in shall be corrected by the real property owner or their designee to meet OFC and ODJFS regulation and request a re-inspection for approval.

  • Fire inspector completing and serving this report as a document of findings

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