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