Safety Survey

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

EMERGENCY ACCESS

• Emergency Number - must be plainly visible on all phones.<br>

  Safe

  At Risk

  N/A

• First Aid Kit Available <br>

  Safe

  At Risk

  N/A

EXITS

• Blocked exitways - exits, aisles, corridors and stairways must be unobstructed.<br>

  Safe

  At Risk

  N/A

• Doors - must be operable from the inside by a single unlocking/unlatching action<br>

  Safe

  At Risk

  N/A

• Exit illumination - exit signs and exit pathways must remain illuminated while building is occupied.<br>

  Safe

  At Risk

  N/A

FIRE EXTINGUISHERS, FIRE PROTECTION SYSTEMS AND EQUIPMENT

• Access - must be maintained to equipment / hydrants.<br>

  Yes

  No

  N/A

• Sprinklers - must be serviced and certified every five years; maintenance must be performed quarterly.<br>

  Safe

  At Risk

  N/A

• Extinguishers - serviced yearly and after each use; mounted 3’ to 5' above the floor; post signs identifying locations of extinguishers when not readily visible.<br>

  Safe

  At Risk

  N/A

• Alarms - waterflow (sprinkler system) alarm must be tested quarterly and other fire alarms routinely.<br>

  Safe

  At Risk

  N/A

ELECTRICAL

• Flexible wiring - may not be used as a substitute for permanent wiring, nor may it pass through walls, ceilings, or floors; permanent wiring should be installed under permit.<br>

  Safe

  At Risk

  N/A

• Multi-plug power strips - are acceptable when listed, have a built-in circuit breaker, and are not rated for more than 15 amps.<br>

  Safe

  At Risk

  N/A

• Circuit panel clearance - maintain access (30" clearance)<br>

  Safe

  At Risk

  N/A

• Labeling - “ELECTRICAL ROOM” door and all circuits must be identified.<br>

  Safe

  At Risk

  N/A

FIRE-RESISTIVE CONSTRUCTION

• Fire assemblies - doors (including automatic roll-down types), windows, and shaft openings which are required to be self-closing or automatic-closing must be maintained in working order.<br>

  Safe

  At Risk

  N/A

• Fire-resistive construction - any such construction which has been damaged must be restored to its original condition.<br>

  Safe

  At Risk

  N/A

GENERAL FIRE SAFETY

• Combustible storage - maintain 24" clearance below ceiling; not allowed in exits, exit enclosures, boiler, mechanical or main electrical rooms or underneath buildings.<br>

  Safe

  At Risk

  N/A

• Maintain clearance around heat-producing equipment.<br>

  Safe

  At Risk

  N/A

• Dumpster clearance - provide 5' clearance from combustible wall/roof of nearest structure.<br>

  Safe

  At Risk

  N/A

• Gas meters, regulators, piping - protect from vehicles.

  Safe

  At Risk

  N/A

OTHER ITEMS

• Other Items

• Photo(s)

  Media

Name of Signature of Inspector

• Name of Inspector

  Sign

• Date & Time of Inspection

  Date

• Inspector's Notes