CTIONS COMPLETED SINCE LAST INSPECTION






























Person completing inspection signature
Date










Facility Fire Marshal signature

Date


CC:
Facility Fire/Safety file

Facility Fire Marshal

Addendum B for DYC Policy 8.1
3/00
2
EMERGENCY PLANS
LOOK FOR
YES
NO
N/A
COMMENT
Emergency Plan reviewed/approved by authority having
jurisdiction within last 12 months?




Current Evacuation Plan posted?




Employees and juveniles drilled within last 30 days?




Juveniles instructed in fire emergency
procedures?
Does emergency plan include repair of equipment?




Is there Emergency communication back-up?




Is there an emergency client release back-up?




Is the local Fire Department/Authority familiar with
facility emergency plan and any recent changes?




Has the local Fire Department/Authority visited and
reviewed the facility emergency plan within the past 12
months?





FIRE DRILLS
LOOK FOR
YES
NO
N/A
COMMENTS
One drill conducted per shift per quarter in client
buildings?




One drill conducted per month in school buildings?




Was building evacuated/ moved to area of refuge within
180 seconds?




Did staff demonstrate quick and complete control of the
drill?




Rooms/area cleared and head count
conducted?

If alarm pull station was activated did system function
properly?




Was drill at unexpected time?




Did drill simulate realistic situation and not repeat
recent drill?




Have staff and juveniles been drilled on secondary
evacuation routes?





KEYS
LOOK FOR
YES
NO
N/A
COMMENTS
Are the keys used to unlock egress doors individually
identifiable by touch and sight?




Do all staff carry keys for juvenile egress?




Do all staff carry keys for fire extinguisher doors?





FIRE EXTINGUISHERS
LOOK FOR
YES
NO
N/A
COMMENTS
Are extinguisher locations marked?




Is there more than 75 feet of travel distance between
extinguishers?




Are monthly inspections being conducted?




Is last annual inspection within the past 12 months?




Is last hydrostatic test within 5 years?




Is extinguisher mounted so that instructions can be read?



Are seals and tamper indicators okay?




Is there damage, corrosion, leakage or clogged nozzles?




Does the weight or heft indicate that extinguishers are



Addendum B for DYC Policy 8.1
3/00
3
full?
Does pressure gauge indicate the extinguishers are ready
for use?




All new staff members trained on extinguisher use?




All staff members given refresher training within past
12 months?




Do all staff members know where extinguishers are
located and have keys?





STAFFING
LOOK FOR
YES
NO
N/A
COMMENTS
Is the facility control center staffed 24 hours a day?




Is staff adequate to unlock doors per Life Safety Code?





FURNISHINGS
LOOK FOR
YES
NO
N/A
COMMENTS
Is combustible personal property stored in non-
combustible container?




Are all facility wastebaskets
nonflammable?

Are curtains, mattresses, carpets, and cushioned
furniture flame retardant?




Are combustible decorations flame retardant treated?




Does juvenile artwork, teaching materials or posters
exceed 20% of the total wall space?





HAZARDOUS MATERIALS
LOOK FOR
YES
NO
N/A
COMMENTS
Does the facility contain more than 10 gallons
(collective total) of Class I, II or III flammable liquids?




Are flammable liquids stored in proper containers?




Are MSDSs readily available for staff in area where
chemical is used/stored?




Is Personal protective equipment available for juveniles
and staff using chemicals?




Is Oxygen sign posted?





EXITS
LOOK FOR
YES
NO
N/A
COMMENTS
Are all means of egress free of storage of any kind?
(This includes ramps, corridors, stairs, etc)




Are all locks, self-closing doors, handrails, etc. in exit
path functioning properly?




Are all fire doors marked with a Fire Door Keep
Closed sign?




Are all fire doors kept closed or equipped with a self-
closing device?




Are all corridors, exits, ramps and stairs illuminated to
at least 1 foot-candle?




Are all exit signs illuminated to at least 5 foot-candles?






Addendum B for DYC Policy 8.1
3/00
4
EMERGENCY LIGHTING
LOOK FOR
YES
NO
N/A
COMMENTS
Do all means of egress have emergency lighting?




Have all emergency lighting units been tested for 30
seconds within the past 30 days?




If power failure occurred within the past 30 days did
emergency lighting come on?





ELECTRICAL
LOOK FOR
YES
NO
N/A
COMMENTS
Have any circuit breakers tripped or fuses blown within
the past 30 days?




Are all electrical boxes equipped with an undamaged
cover?




Are there any exposed bare wires or frayed insulation?




Are all cords and plugs in good condition and are
ground plugs okay?




Does the facility electrician approve all extension cords?



Are electrical switches, switch plates or outlets cracked,
broken or have exposed contacts?




Are all electric panels locked and the surrounding three
feet of space clear?




Are all electrical panel switches and circuit breakers
identified?





FIRE ALARMS
LOOK FOR
YES
NO
N/A
COMMENTS
Has the fire alarm system gone into alarm within the
past 30 days? If so, is there a drill report? List date(s) in
comments section.




Is the alarm panel indicating that it is operational?




Are a portion of the smoke detectors tested in each
alarm circuit each quarter?




Have all smoke detectors been tested within the past 12
months?




Are all manual fire alarm pull stations accessible and
unobstructed?




Where the staff transmit the fire alarm signal to the local
Fire Department/Authority:
Is an operator or staff member on duty at all times?




Does the operator/staff have emergency procedures
readily available?




Have automatic detection systems transmitting trouble
alarms to this station been tested in the past 30 days?




Have automatic detection systems transmitting water
flow alarms to this station been tested within the past 60
days?




Have automatic detection systems transmitting manual
pull station alarms been tested within the past 6 months?




Have alarm reports been kept on file for the past 12
months




If the fire alarm system automatically transmits the
alarm to the Fire Department,
Has it been tested in past 30 days?



Addendum B for DYC Policy 8.1
3/00
5

EMERGENCY GENERATOR
LOOK FOR
YES
NO
N/A
COMMENTS
Have the emergency generators been tested within the
past 30 days?




Does each emergency generator have at least a 24 hour
fuel supply?




Has each emergency generator been tested under a load
within the past 6 months?





FIRE SUPPRESSION SYSTEM
LOOK FOR
YES
NO
N/A
COMMENTS
Are all fire hydrants visible and readily accessible?




Are Fire Department connections visible and accessible?



Do fire hydrant connections have caps?




Are sprinkler pipes and heads in good condition?




Is a zone of 18 inches below the sprinkler head kept
clear of materials?




Is a stock of sprinkler heads available?




Have quarterly inspections been documented on
sprinkler heads?




Has sprinkler system been inspected in the past 12
months?




Is the sprinkler system operational?




Have sprinklers been activated in past 30 days?




Are there any trouble indicators on printouts?




Are kitchen hoods equipped with an automatic sprinkler
system?




Has the kitchen hood sprinkler system been tested
within the past 6 months?





COMPARTMENTALIZATION
LOOK FOR
YES
NO
N/A
COMMENTS
Have areas of refuge been identified?




Are areas of refuge being used for evacuation during
drills?




Are one hour rated doors or automatic sprinklers
installed in the boiler room, furnace room, fuel storage
areas, janitorial closets, maintenance shops, laundry
rooms, kitchens and general storage areas?




Are portable space heaters prohibited within the facility?



Are there any firewall penetrations that are not sealed?




Do all fire/smoke doors close and latch?




Is there more that ¾ inch gaps on any side of fire doors?



Is wire glass and metal frames used in windows in any
firewall or fire door where sprinklers are not present?




Are laundry rooms ventilated and dryer lint traps clean?




Are laundry chutes compartmentalized and do doors
latch?




* NOTE Lexan may be used in fire doors and walls if the building has an automatic sprinkler system.


Addendum B for DYC Policy 8.1
3/00
6

HEATING, VENTILATION AND AIR CONDITIONING
LOOK FOR
YES
NO
N/A
COMMENTS
Are smoke dampers installed in ductwork that goes
through a firewall? Has it been tested within the past 12
months?




Are flammable liquids stored in well-ventilated areas?





SMOKING
LOOK FOR
YES
NO
N/A
COMMENTS
Is the facility smoking policy being followed?




Is designated smoking area clean and free of potential
fire hazards?