Potomac JCC Weekly Inspection Dormitory

• Conducted on

  Date

• Prepared by

• Centers are required to conduct and document weekly/monthly inspections. Results of the inspection are recorded below. In the event a deficiency is identified but cannot be corrected, the Safety Officer will submit a maintenance work order. Completed checklist must be returned to the Center Safety Officer,based on center policy. The general safety and health checklist applies and should be attached to the checklist.

• Area of inspection.

  Yes

  No

  N/A

• Inspection completed by?

  Yes

  No

  N/A

• Date and Time of inspection

  Date

General Requirements

• All students doors or any door leading to an egress corridor must positive latch on its own. No door can be held open by any device that will not release the door when the fire alarm is activated.

  Yes

  No

  N/A

• All entrance/exit doors to egress corridors are fully operational and bear then appropriate for rating. Frame and door have a fire rating tag. Doors are free from holes and breakage.

  Yes

  No

  N/A

• All panic bars are in good working condition and operational.

  Yes

  No

  N/A

• All ceiling tile are in place and there are no holes or gaps in excess of 1/8th.

  Yes

  No

  N/A

• All electrical panels are labeled appropriately.

  Yes

  No

  N/A

• All electrical panels have a 3 foot entry way to panel. Panel doors close and lock.

  Yes

  No

  N/A

• All G.F.C.I. receptacles are operational.

  Yes

  No

  N/A

• Electrical panel knockouts are in place.

  Yes

  No

  N/A

• Permanent electrical circuits are utilized rather than extension cords.

  Yes

  No

  N/A

• Area is free of missing tiles both floor and wall.

  Yes

  No

  N/A

• Materials are safety stacked and not within 18" vertically or 36" horizontally of a sprinkler head.

  Yes

  No

  N/A

• Light fixtures are free of missing lens covers.

  Yes

  No

  N/A

• Walking surfaces are free of spilled liquids or water.

  Yes

  No

  N/A

• Sidewalks and other walking surfaces are free of cracks in excess of 1/4".<br><br><br>

  Yes

  No

  N/A

• All exterior lighting is operational.

  Yes

  No

  N/A

• Cleaning materials and chemicals are properly stored, not in students rooms, or left unattended.

  Yes

  No

  N/A

• All flammable or hazardous chemicals are properly stored when not in use. Flammable storage cabinets are closed at all times.

  Yes

  No

  N/A

• Dryer vents are clean and properly attached.

  Yes

  No

  N/A

Safety

• Fire extinguishers are; (A) Present (B) Proper class (C) Properly mounted (D) Adequate in number (E) Unobstructed

  Yes

  No

  N/A

• Sprinkler system is; (A) Properly installed (B) Inspected (C) Escutcheons are present (D) Properly spaced

  Yes

  No

  N/A

• Emergency lighting is (A) Properly installed (B) Adequate (C) Properly functioning

  Yes

  No

  N/A

• Exit signage is; (A) Properly installed (B) Adequate (C) Property functioning (D) Indicates proper egress

  Yes

  No

  N/A

• Emergency egress is unobstructed and egress lighting is functional.

  Yes

  No

  N/A

• CO2 detectors are (A) Present (B) Properly located (C) Properly functioning.

  Yes

  No

  N/A

• All fire egress maps include; (A) Primary and secondary escape routes (B) You are here marking (C) Location of alarm pull stations and fire extinguishers.

  Yes

  No

  N/A

• Fire alarm system is; (A) Properly installed (B) Functional (C) Adequate.

  Yes

  No

  N/A

• Signature of inspector/Area Supervisor

  Sign

• Safety Officer/ Safety & Security Manager

  Sign