Test Form 2FIRE STATIONQuarterly Facility Safety Inspection FormDateFacilityPerson Conducting InspectionEmployee #GENERAL SAFETYSafety programs available for employee reviewSelect OptionCompleteN/AAction Needed-- Recommended ActionSafety posters are displayed as requiredSelect OptionCompleteN/AAction Needed-- Recommended ActionHazard assessment process is being done as requiredSelect OptionCompleteN/AAction Needed-- Recommended ActionWORK AREAWorksites are kept clean and orderlySelect OptionCompleteN/AAction Needed-- Recommended ActionCombustible waste is removed from premises dailySelect OptionCompleteN/AAction Needed-- Recommended ActionSpills and leaks are cleaned up immediatelySelect OptionCompleteN/AAction Needed-- Recommended ActionFloor surfaces are in good repairSelect OptionN/AAction Needed-- Recommended ActionHeavy items stored low, light items stored highSelect OptionCompleteN/AAction Needed-- Recommended ActionLadders are available and in good conditionSelect OptionCompleteN/AAction Needed-- Recommended ActionShelves and cabinets secured to prevent topplingSelect OptionCompleteN/AAction Needed-- Recommended ActionHanging items, appliance equipment secure in place-- Recommended ActionLighting is adequate for job condition-- Recommended ActionTrip hazards are clearly marked (steps and stairs)-- Recommended ActionPlumbing fixtures are working properly, no leaks-- Recommended ActionToilets and washing facilities kept sanitary-- Recommended ActionFurniture is kept in good repair-- Recommended ActionWindows & glass doors are in good order, no cracks-- Recommended ActionDoors between apparatus room and other areas closed-- Recommended ActionEating and drinking are done in appropriate areas-- Recommended ActionEQUIPMENT/TOOLSPower equipment is in good working condition-- Recommended ActionTools are in good condition & replaced when damaged-- Recommended ActionAdequate clearance is maintained near machinery-- Recommended ActionEmployee protective equipment is available and used-- Recommended ActionEmergency eye wash/showers operate properly-- Recommended ActionProtective machine guards are in place-- Recommended ActionOnly authorized personnel permitted in work area-- Recommended ActionLift truck policies are enforced-- Recommended ActionEXITING-- Recommended ActionHallways, corridors & exits are clear of obstacles-- Recommended ActionAll exit door hardware is operable-- Recommended ActionEmergency lighting is in working order-- Recommended ActionFIRE PROTECTIONPortable fire extinguishers are available & serviced-- Recommended ActionNo smoking policies are enforced-- Recommended ActionTest smoke detectors; replace battery Jan & July-- Recommended ActionCombustible storage kept away from ignition sources-- Recommended ActionStorage is kept below 24" of ceiling, no sprinklers-- Recommended ActionStorage is kept 18" below sprinkler heads-- Recommended ActionSprinkler heads not obstructed or damaged-- Recommended ActionSprinkler heads and wrench are available-- Recommended ActionSprinkler system valves in “OPEN” position-- Recommended Action30" clearance of combustibles from heating equipment-- Recommended ActionSprinkler system 5 yr. service completed/tagged-- Recommended ActionHoods above cooking equip are in good order/clean-- Recommended ActionAddress numbering is visible from the street-- Recommended ActionFire lanes are kept clear-- Recommended ActionEmergency fuel shutoffs are clearly marked & tested-- Recommended ActionWelding/flame cutting policies are enforced-- Recommended ActionELECTRICAL-- Recommended ActionElectrical fixtures and wiring are in good repair-- Recommended ActionOnly approved extension cords are in use-- Recommended Action30" clearance in front of electrical panel-- Recommended ActionGround fault interrupters near water sources 0 0 0 are in good working order-- Recommended ActionHAZARDOUS MATERIALSOily rags are kept in approved metal container-- Recommended ActionStorage of flammables are in approved locations-- Recommended ActionHazardous materials are stored safely-- Recommended ActionAll containers are properly labeled-- Recommended ActionBiohazards are properly disposed of-- Recommended ActionMISCELLANEOUSH.V.A.C. equipment in good working order-- Recommended ActionPits and floor openings are covered/protected-- Recommended ActionOverhead doors are in good working order-- Recommended ActionAir compressor unit in good working order/inspected-- Recommended ActionCompressed gas cylinders are secured-- Recommended ActionExhaust removal systems work properly-- Recommended ActionGates and fence components securely standing-- Recommended ActionOTHERDATE AND SIGNName of InspectorDateThere was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
