Test Form 2 FIRE STATION Quarterly Facility Safety Inspection Form Date Facility Person Conducting Inspection Employee # GENERAL SAFETY Safety programs available for employee reviewSelect Option Complete N/A Action Needed -- Recommended Action Safety posters are displayed as requiredSelect Option Complete N/A Action Needed -- Recommended Action Hazard assessment process is being done as requiredSelect Option Complete N/A Action Needed -- Recommended Action WORK AREA Worksites are kept clean and orderlySelect Option Complete N/A Action Needed -- Recommended Action Combustible waste is removed from premises dailySelect Option Complete N/A Action Needed -- Recommended Action Spills and leaks are cleaned up immediatelySelect Option Complete N/A Action Needed -- Recommended Action Floor surfaces are in good repairSelect Option N/A Action Needed -- Recommended Action Heavy items stored low, light items stored highSelect Option Complete N/A Action Needed -- Recommended Action Ladders are available and in good conditionSelect Option Complete N/A Action Needed -- Recommended Action Shelves and cabinets secured to prevent topplingSelect Option Complete N/A Action Needed -- Recommended Action Hanging items, appliance equipment secure in place -- Recommended Action Lighting is adequate for job condition -- Recommended Action Trip hazards are clearly marked (steps and stairs) -- Recommended Action Plumbing fixtures are working properly, no leaks -- Recommended Action Toilets and washing facilities kept sanitary -- Recommended Action Furniture is kept in good repair -- Recommended Action Windows & glass doors are in good order, no cracks -- Recommended Action Doors between apparatus room and other areas closed -- Recommended Action Eating and drinking are done in appropriate areas -- Recommended Action EQUIPMENT/TOOLS Power equipment is in good working condition -- Recommended Action Tools are in good condition & replaced when damaged -- Recommended Action Adequate clearance is maintained near machinery -- Recommended Action Employee protective equipment is available and used -- Recommended Action Emergency eye wash/showers operate properly -- Recommended Action Protective machine guards are in place -- Recommended Action Only authorized personnel permitted in work area -- Recommended Action Lift truck policies are enforced -- Recommended Action EXITING -- Recommended Action Hallways, corridors & exits are clear of obstacles -- Recommended Action All exit door hardware is operable -- Recommended Action Emergency lighting is in working order -- Recommended Action FIRE PROTECTION Portable fire extinguishers are available & serviced -- Recommended Action No smoking policies are enforced -- Recommended Action Test smoke detectors; replace battery Jan & July -- Recommended Action Combustible storage kept away from ignition sources -- Recommended Action Storage is kept below 24" of ceiling, no sprinklers -- Recommended Action Storage is kept 18" below sprinkler heads -- Recommended Action Sprinkler heads not obstructed or damaged -- Recommended Action Sprinkler heads and wrench are available -- Recommended Action Sprinkler system valves in “OPEN” position -- Recommended Action 30" clearance of combustibles from heating equipment -- Recommended Action Sprinkler system 5 yr. service completed/tagged -- Recommended Action Hoods above cooking equip are in good order/clean -- Recommended Action Address numbering is visible from the street -- Recommended Action Fire lanes are kept clear -- Recommended Action Emergency fuel shutoffs are clearly marked & tested -- Recommended Action Welding/flame cutting policies are enforced -- Recommended Action ELECTRICAL -- Recommended Action Electrical fixtures and wiring are in good repair -- Recommended Action Only approved extension cords are in use -- Recommended Action 30" clearance in front of electrical panel -- Recommended Action Ground fault interrupters near water sources 0 0 0 are in good working order -- Recommended Action HAZARDOUS MATERIALS Oily rags are kept in approved metal container -- Recommended Action Storage of flammables are in approved locations -- Recommended Action Hazardous materials are stored safely -- Recommended Action All containers are properly labeled -- Recommended Action Biohazards are properly disposed of -- Recommended Action MISCELLANEOUS H.V.A.C. equipment in good working order -- Recommended Action Pits and floor openings are covered/protected -- Recommended Action Overhead doors are in good working order -- Recommended Action Air compressor unit in good working order/inspected -- Recommended Action Compressed gas cylinders are secured -- Recommended Action Exhaust removal systems work properly -- Recommended Action Gates and fence components securely standing -- Recommended Action OTHER DATE AND SIGN Name of Inspector Date There was a problem saving your submission. 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