Audit

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 sq ft, with smoke detection, and arranged to not obstruct exit access?

A4.2. In all patient sleeping rooms >1000 sq ft, 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 200 ft 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 200 ft?

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/or any other Life Safety systems component unobstructed?

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 head?

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 75 ft 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 or Supervisor Notified
Life Safety Compliance Specialist
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.