Frenkil Building Monthly Inspection (updated 4/12/18)

• Document No.

• Audit Title Monthly Inspection

• Client / Site UMMS - Frenkil Building

• Conducted on

  Date

• Prepared by Ted Saunders, CFPS

• Add location
  Address

• Personnel

Functional testing of emergency/exit lighting is conducted during a monthly inspection for not less than 30 seconds, except as otherwise permitted per NFPA 101 7.9.3.1(2) Inspection of fire extinguisher includes checking that pin is still in place, seal isn’t broken, inspection tag isn’t past due, and tag is dated and signed by auditor.

5th Floor Exit Lights

• Exit lights are functional.

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Near mechanical room

  Yes

  No

  N/A

• Inside & outside suite 510 (x2)

  Yes

  No

  N/A

• Elevator lobby exit door

  Yes

  No

  N/A

• Inside & outside double doors (x2)

  Yes

  No

  N/A

• Inside entrance to suite 500

  Yes

  No

  N/A

• Near room 531 (IT)

  Yes

  No

  N/A

• Near Chinneta-Pettaway office

  Yes

  No

  N/A

• Near rear exit of suite 500 (x2)

  Yes

  No

  N/A

5th Floor Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Machine room - #3761

  Yes

  No

  N/A

• Hallway - #3759

  Yes

  No

  N/A

• Inside suite 500 (near exit) #3762

  Yes

  No

  N/A

• Inside suite 500 (near receptionist) #3763

  Yes

  No

  N/A

• Freight elevator hall - #3760

  Yes

  No

  N/A

• Inside suite 510 (PT) #3764

  Yes

  No

  N/A

4th Floor Exit Lights

• Exit lights are functional.

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Inside rear hall leading to FR (x2)

  Yes

  No

  N/A

• Outside mechanical room (x2)

  Yes

  No

  N/A

• Inside & outside double doors (x2)

  Yes

  No

  N/A

• Elevator lobby exit door

  Yes

  No

  N/A

• Near staff lounge

  Yes

  No

  N/A

• Near exam room #3

  Yes

  No

  N/A

• Near treatment & testing

  Yes

  No

  N/A

• Near waiting room (back hall)

  Yes

  No

  N/A

• In waiting area

  Yes

  No

  N/A

• In lobby area near fire extinguisher

  Yes

  No

  N/A

4th Floor Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Lobby - #3764

  Yes

  No

  N/A

• Waiting area - #3767

  Yes

  No

  N/A

• Exam room 1 - #3765

  Yes

  No

  N/A

• Exam room 5 - #3767

  Yes

  No

  N/A

• Restroom (outside hall) #3766

  Yes

  No

  N/A

• Freight elevator hall - #3779

  Yes

  No

  N/A

• Mechanical room - #3769

  Yes

  No

  N/A

3rd Floor Exit Lights

• Exit lights are functional.

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Rear hall to freight elevator

  Yes

  No

  N/A

• Near staff lounge (x2)

  Yes

  No

  N/A

• Outside conference room

  Yes

  No

  N/A

• At "employees only" door

  Yes

  No

  N/A

• Inside & outside double doors (x2)

  Yes

  No

  N/A

• Elevator lobby exit door

  Yes

  No

  N/A

• Near exam room 12

  Yes

  No

  N/A

• Near exam room 9

  Yes

  No

  N/A

• Near exam room 2

  Yes

  No

  N/A

• Near procedure room B

  Yes

  No

  N/A

• Rear hall leading to lobby

  Yes

  No

  N/A

3rd Floor Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• At freight elevator- #3778

  Yes

  No

  N/A

• Exam room 16 (outside) #3774

  Yes

  No

  N/A

• Exam room 12 (outside) #3773

  Yes

  No

  N/A

• Exam room 3 (outside) #3771

  Yes

  No

  N/A

• Infusion room 1 - #3772

  Yes

  No

  N/A

• Lobby - #3770

  Yes

  No

  N/A

• Mechanical room (inside break room) #3775

  Yes

  No

  N/A

2nd Floor Exit Lights

• Exit lights are functional.

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Near room 255 (x2)

  Yes

  No

  N/A

• Near room 248

  Yes

  No

  N/A

• Near room 250

  Yes

  No

  N/A

• Near room 243

  Yes

  No

  N/A

• Near room 242

  Yes

  No

  N/A

• Near women's restroom

  Yes

  No

  N/A

• At double doors (inside & outside)

  Yes

  No

  N/A

• Elevator lobby exit door

  Yes

  No

  N/A

• Near room 218

  Yes

  No

  N/A

• Near room 225

  Yes

  No

  N/A

• Near room 208

  Yes

  No

  N/A

• Near room 214

  Yes

  No

  N/A

• Near room 205

  Yes

  No

  N/A

• Near room 201 (& conf. Room)

  Yes

  No

  N/A

• Lobby area near nurse's station

  Yes

  No

  N/A

2nd Floor Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Freight elevator #3777

  Yes

  No

  N/A

• Lobby #3776

  Yes

  No

  N/A

• Mechanical room (inside utility room) #3780

  Yes

  No

  N/A

1st Floor Exit Lights

• Exit lights are functional.

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Outside mechanical room (x2)

  Yes

  No

  N/A

• In front of security desk

  Yes

  No

  N/A

• Near lab sign in lobby

  Yes

  No

  N/A

• Inside phlebotomy

  Yes

  No

  N/A

• At main entrance

  Yes

  No

  N/A

• EJC near consult room 1

  Yes

  No

  N/A

• EJC near exam room 4

  Yes

  No

  N/A

• EJC near exam room 8

  Yes

  No

  N/A

• EJC near exam room 9

  Yes

  No

  N/A

• EJC at rear exit

  Yes

  No

  N/A

• EJC above fire extinguisher

  Yes

  No

  N/A

1st Floor Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Freight elevator hallway #3782

  Yes

  No

  N/A

• Main hall near restrooms #3784

  Yes

  No

  N/A

• Machine room #3783

  Yes

  No

  N/A

• EJC (rear) #3781

  Yes

  No

  N/A

Basement Exit Lights

• Exit lights are functional

• Freight elevator (rear exit)

  Yes

  No

  N/A

• Near fire extingiuisher

  Yes

  No

  N/A

• Near light room

  Yes

  No

  N/A

• Hallway near room 070 (inside and outside)

  Yes

  No

  N/A

• Near staff restrooms

  Yes

  No

  N/A

• Elevator lobby

  Yes

  No

  N/A

• Near vending machine

  Yes

  No

  N/A

• Inside vending machine lounge

  Yes

  No

  N/A

• Inside office 020

  Yes

  No

  N/A

• Near EJC conference room 050 (x2)

  Yes

  No

  N/A

• Near medical records entrance 051 (x3)

  Yes

  No

  N/A

• Inside medical records (x3)

  Yes

  No

  N/A

Basement Fire Extinguishers

• Extinguishers are charged, mounted, tagged and intact.

• Freight elevator hall #3786

  Yes

  No

  N/A

• Hallway #3785

  Yes

  No

  N/A

• Elevator room 2 #3789

  Yes

  No

  N/A

• Light room #33

  Yes

  No

  N/A

• Pump room (inside break room) #7

  Yes

  No

  N/A

• Telephone room #5

  Yes

  No

  N/A

• Elevator room 1 (near stair 1)

  Yes

  No

  N/A

Inspection to identify all fire hazards, obstacles and evacuation routes, and other unsafe conditions

• Clear of all fire hazards, obstacles in evacuation routes, and other unsafe conditions

  Yes

  No

  N/A

• Additional notes

• Add signature

  Sign