Lucknow Town Hall (complete)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 1. Front Lobby door exit pack working and signed off?

  Yes

  No

  N/A

• 2. Exit pack over Library Door working and signed off?

  Yes

  No

  N/A

• 3. Exit pack over rear exit of library door working and signed off?

  Yes

  No

  N/A

• 4. Back Stairwell door, Lower level working and signed off?

  Yes

  No

  N/A

• 5. Hawk theater rear exit sign working and signed off?

  Yes

  No

  N/A

• 6. Exit pack by furnace room in rear stairwell working and signed off?

  Yes

  No

  N/A

• 7. 3rd level Hawk Main doors exit pack; lobby side working and signed off?

  Yes

  No

  N/A

• 8. 3rd level Hawk Main doors exit pack; theater side working and signed off?

  Yes

  No

  N/A

• 9. Stairwell in basement exit pack working and signed off?

  Yes

  No

  N/A

• 10. Main basement area near kitchenette exit pack working and signed off?

  Yes

  No

  N/A

• 11. Basement back door exit pack working and signed off?

  Yes

  No

  N/A

• Add signature

  Sign

Fuel

• Is there adequate fuel levels - record - are they within 30%

  Yes

  No

  N/A

Furnace room

Carrier Performance Boost 90

• Listen for any abnormalities in operation - does the unit sound consistent in normal operation?

  Yes

  No

  N/A

• Inspect the air filters, is the air filter clean? (replacement is 16x25x1)

  Yes

  No

  N/A

• While running take a heat temperature with the infared from the heating vents - is it blowing within normal specs?

  Yes

  No

  N/A

• Is the inside cabinet of the unit free of debris and or water?

  Yes

  No

  N/A

• Check all fittings to ensure that they are secure, is the unit in good working order

  Yes

  No

  N/A

• 1. Front Entrance extinguisher charged and signed off?

  Yes

  No

  N/A

• 2. Library extinguisher charged and signed off?

  Yes

  No

  N/A

• 3. Library rear entrance exinguisher charged and signed off?

  Yes

  No

  N/A

• 4. Hawk Theater front entrance extinguisher charged and signed off?

  Yes

  No

  N/A

• 5. Hawk Theater by stage extinguisher charged and signed off?

  Yes

  No

  N/A

• 6. Basement by kitchen extinguisher charged and signed off?

  Yes

  No

  N/A

• 7. Basement by west exit extinguisher charged and signed off?

  Yes

  No

  N/A

• 8. Basement in card room extinguisher charged and signed off?

  Yes

  No

  N/A

• Add signature

  Sign

First Aid box in kitchen

• Is Regulations 1101 present

• Current edition of a standard St John's First Aid Manual

• 12 adhesive dressings individually wrapped

• 4 sterile gauze pads 3" square

• 2 rolls of gauze bandages 2" wide

• 2 field dressings, 4 inches square or 2 four-inch sterile bandage compresses

• 1 Triangular Badage

First Aid Kit in basement maintenance room

• Is Regulations 1101 present

• Current edition of a standard St John's First Aid Manual

• 12 adhesive dressings individually wrapped

• 4 sterile gauze pads 3" square

• 2 rolls of gauze bandages 2" wide

• 1 Triangular Badage

• 2 field dressings, 4 inches square or 2 four-inch sterile bandage compresses

• 1 Triangular Badage

Building exterior/parking lot

• Are all outside areas safe and accessible?

  Yes

  No

  N/A

• Are walkways clear of snow or obstruction?

  Yes

  No

  N/A

• Are all lights working?

  Yes

  No

  N/A

• Are the entrance ways clean and free of debris (cigarette butts)?

  Yes

  No

  N/A

Town Hall Entrance and Stairwells

• Are floors clean and free of debris or slip/trip hazards?

  Yes

  No

  N/A

• Are walls clean and smudge free?

  Yes

  No

  N/A

• is there adequate lighting in walking and work areas, record any burnt out bulbs.

  Yes

  No

  N/A

• Are garbage receptacles adequate and clean?

  Yes

  No

  N/A

• Are the stair treds clean leading to the basement

  Yes

  No

  N/A

• Is the carpet on the stairs leading to Hawk Theater clean and in good condition?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in their proper place?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Front Entrance Washrooms

• Are Sinks, mirrors and toilets clean and in working order?

  Yes

  No

  N/A

• Are the hand dryer/paper towel dispensers clean and in good working order?

  Yes

  No

  N/A

• Are the hand soap pumps clean, full and in good working order?

  Yes

  No

  N/A

• Toilet paper holders stocked and in working condition?

  Yes

  No

  N/A

• Are stall dividers clean and in good working condition?

  Yes

  No

  N/A

• Floors swept/cleaned and free of debris?

  Yes

  No

  N/A

• is there adequate lighting in walking and work areas, record any burnt out bulbs.

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Library Main area

• Counters and Sinks clean and free debris?

  Yes

  No

  N/A

• Floor swept and clean free of debris?

  Yes

  No

  N/A

• is there adequate lighting in walking and work areas, record any burnt out bulbs.

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Library Computer Area

• Counters and Sinks clean and free debris?

  Yes

  No

  N/A

• Floor swept and clean free of debris?

  Yes

  No

  N/A

• is there adequate lighting in walking and work areas, record any burnt out bulbs.

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Basement Washrooms

• Are Sinks, mirrors and toilets clean and in working order?

  Yes

  No

  N/A

• Are the hand dryer/paper towel dispensers clean and in good working order?

  Yes

  No

  N/A

• Are the hand soap pumps clean, full and in good working order?

  Yes

  No

  N/A

• Toilet paper holders stocked and in working condition?

  Yes

  No

  N/A

• Are stall dividers clean and in good working condition?

  Yes

  No

  N/A

• Floors swept/cleaned and free of debris?

  Yes

  No

  N/A

• is there adequate lighting in walking and work areas, record any burnt out bulbs.

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Equipment/Maintenance room

• Are tools put away in an orderly fashion and in good condition?

  Yes

  No

  N/A

• Is there adequate storage and shelving? Is the shelving in good condition and safe?

  Yes

  No

  N/A

• Are the walls clean and free of mould and smudges?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Basement Area

• is there adequate lighting in walking and work areas, record any burnt out bulbs or missing lenses.

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• Is there adequate storage and shelving? Is the shelving in good condition and safe?

  Yes

  No

  N/A

• Are the walls clean and free of mould and smudges?

  Yes

  No

  N/A

• Are the carpets clean and stain free? Have they been vaccumed?

  Yes

  No

  N/A

• If everything passes click Yes/if work required click no and report on additional issues

  Yes

  No

  N/A

Hawk Theater

• Are Ceiling tiles stain free and in there proper place?

  Yes

  No

  N/A

• Are the walls clean and free of mould and smudges?

  Yes

  No

  N/A

• Is there adequate lighting in the theater are all bulbs functioning

  Yes

  No

  N/A

• Are the air return/heat vents clean and dust free?

  Yes

  No

  N/A

• Add signature

  Sign