Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
1. Previous Inspection
-
1.1 Has the previous Life Safety Inspection been reviewed?
-
1.2 Have previous discrepancies been resolved?
-
1.3 Do the facility's Life Safety drawing match current conditions?
A1. Fire Doors
-
A1.1. Are fire doors provided with positive latching?
-
A1.2. Is the fire door self-closing or automatic closing?
-
A1.3. Is the gap between fire doors 1/8" or less and the gap between the fire door and the floor 3/4" or less?
-
A1.4. Is the fire door free from decorations, door stops, unprotected penetrations, and non-rated hardware?
-
A1.5. Is the fire door free from damaged hardware?
-
A1.6. Does the fire door and frame each have a label indicating the rating?
-
A1.7. If the rated door has a window, does the window have fire wire and or a fire rated label?
A2. Fire rated walls, ceiling, and floors.
-
A2.1. Are penetrations in rated walls as provided on the facility's life safety drawings properly sealed with fire rated material?
-
A2.2. Are penetrations in floors and ceiling properly sealed with fire rated material?
A3. Fire alarm and sprinkler systems.
-
A3.1. Does the fire alarm panel/power supply have a smoke detector above it?
-
A3.2. Does the fire alarm panel/power supply show all systems normal?
-
A3.3. Is the sprinkler piping free from wires, tape, or any other items not allowed per code?
-
A3.4. Are all sprinkler heads with escutcheon plates?
-
A3.5. Where quick response type sprinkler heads are being used are all heads within the compartment of the quick response type?
-
A3.6.Is sprinkler protection provided throughout the compartment?
A4. Rooms
-
A4.1. Are waiting areas open to the corridor < 600 sqft, with smoke detection, and arranged to not obstruct exit access?
-
A4.2. In all patient sleeping rooms >1000 sqft are there two remotely located exit access doors?
-
A4.3. Are exit access doors < 100 ft from any point in patient sleeping rooms?
-
A4.4. Is the travel distance from any point in the smoke compartment within 200ft of a smoke barrier door?
-
A4.5. Are all soiled linen and trash collection rooms rated at 1 hour?
-
A4.6. Is the travel distance to an approved exit from anywhere within the smoke compartment within 200ft?
A5. Corridors
-
A5.1. Is the corridor constructed as to limit the passage of smoke?
-
A5.2. Are all dead-end corridors less than 30 ft?
-
A5.3. Is there a minimum of 48" of clear width where serving as a means of egress from patient sleeping rooms?
-
A5.4. Are projections into the corridor < 6"?
-
A5.5. Where fixed furniture is located in a corridor that is a minimum of 8ft are all 8 requirements met per section 19.2.3.4(5), LSC 101, 2012 Edition?
-
A5.6. Is there a minimum of 44" in clear width provided in corridors and passageways where patient egress is not intended?
A6. General
-
A6.1. Are exit signs properly illuminated?
-
A6.2. Is there adequate exit signage?
-
A6.3. Are pull stations, exit signs, exit doors, notification appliances, extinguishers, and any other life safety systems component un-obstructed?
-
A6.4. Are fire extinguishers tagged appropriately and within annual certification and with monthly checks?
-
A6.5. Are all stored materials a minimum of 18" from the sprinkler deflector?
-
A6.6. Is the area free from signs of smoking?
-
A6.7. Are electrical panels unobstructed and locked with a minimum storage free space of 30" in width, 36" in depth, and 78" in height?
-
A6.8. Are fire extinguishers installed correctly and within 75ft in any direction?
-
A6.9. Is the compartment in compliance with the current Life Safety Code, NFPA 101?
-
A6.10. Are medical gas shut off valves unobstructed?
Signatures:
-
Were staff members educated and notified of deficiencies found and notified of corrective action process?
-
Unit/Floor Manager Notified
-
Life Safety Compliance Specialist