Fire_Safety_Survey_Worksheet.pdf

FIRE SAFETY SURVEY WORKSHEET

1. Building name, address, and number:

2. Number of Stories Above and Below Grade: ___________________________

3. Lease Expiration Date: ____________________________________________ Building Construction Date: ________________________________________

4. Date of Previous Survey: ___________________________________________

5. Floors on Which Government Occupies Space: _________________________

6. Types of Occupancy Groups

7. Approximate Gross Area Per Floor: __________________________________

8. Number of Federal Occupants: ______________________________________

9. Type of Building Construction: Type _________________________________

10. Type of Floor Construction: ________________________________________

11. Type of Exterior Walls: ______________________________________

12. Type of Roof Construction: _________________________________________

13. Ceiling Finish: ____________________________________________________

14. Wall Finish: ______________________________________________________

15. Floor Finish: ______________________________________________________

16. Partition Construction: ______________________________________________

17. Location and Size of Group II, III & IV Occupancies: ______________________

18. Location and Construction of Occupancy Separation or Fire Walls: ___________

19. Automatic Sprinkler System: _________________________________________ Location: _________________________________________________________ Hydraulics: _______________________________________________________ Fire Department Siamese Connection: __________________________________

20. Standpipe System:

Riser Size: _______________________________________________________ Outlet Size: ______________________________________________________ Outlet Hose: _____________________________________________________ Fire Department Siamese Connection: _________________________________ Waterflow Switches: _______________________________________________ Tamper Switches: _________________________________________________

21. Special Fire Extinguishing Systems: _____________________________________

22. Fire Pump: _______________________________________________________

Size: ____ gpm at _____ psi Power: __________________________________________________________ Location: ________________________________________________________ Supervisory: ______________________________________________________

23. Water Supply: ____________________________________________________

24. Fire Alarm/Communication System:

a. Type of Fire Alarm System: ___________________________________

b. Supervision of Initiating Device Circuits: _________________________

c. Supervision of Indicating Appliance Circuits: ______________________

d. Connection to Fire Department: Yes____No______ Connection to Central Station: ____________________________

e. Initiating Devices: ___________________________________________

f. Notification Appliances: ______________________________________

g. Emergency Telephone System: _________________________________

h. Fire Department Communication System: ________________________

i. Secondary Source of Power: ___________________________________

j. Emergency Control Center:

Location: __________________________________________________ Enclosure: _________________________________________________

25. Exit Considerations:

a. Number of Exits: ___________________________________________

b. Exit Remoteness: ___________________________________________

c. Exit Access: _______________________________________________

d. Exit Enclosure: _____________________________________________

e. Exit Discharge Protection: _____________________________________

f. Step Dimensions: ____________________________________________

26. Emergency Lighting:

Type: ___________________________________________________________ Locations: _______________________________________________________

27. Exit Signs: _______________________________________________________ Secondary Source of Power: _________________________________________

28. Emergency Generator:

Capacity: ___________ kW

Location: ________________________________________________________ Fuel: ____________________________________________________________ Serves: __________________________________________________________

29. Building Heat Source:

Type: ____________________________________________________________ Location: _________________________________________________________ Enclosure: ________________________________________________________ Certificate Date: ___________________________________________________

30. HVAC System:

Source of Heat: ____________________________________________________ Source of Chilled Water: _____________________________________________ Location of Fans: ___________________________________________________ Fire Dampers: ______________________________________________________ Return Air Routing: _________________________________________________

31. Elevator Features:

Number: __________________________________________________________ Firemans Capture: __________________________________________________ Automatic Recall: __________________________________________________ Certificate Date: ___________________________________________________ Telephone in Cab: __________________________________________________

32. Occupant Emergency Organization: ____________________________________

33. Local Fire Department Pre-Fire Plan: ___________________________________

34. Smoke Control: ____________________________________________________

35. Fire Extinguishers:

Types: ____________________________________________________________ Annual Service Date: ________________________________________________ Six-year Service Date: _______________________________________________ Hydrostatic Test Date: _______________________________________________

36. Maintenance of Firesafety Equipment: __________________________________