J-0200000-07 Fire Warden Report.pdf

Fire Warden Report

From: Bldg. Month: Year:

To: jaxs_nas_fireprev@navy.mil

Items Mark Blocks S (Sat) or U (Unsat) 1st

Week 2nd

Week 3rd

Week 4th

Week Fire Extinguishers (full, operable, properly located, seals unbroken, unobstructed).

Extinguisher Log signed Monthly by designated Fire Warden Refuse (removed from in and around building; good housekeeping practices in effect).

Facility (all rooms clean and mostly arranged; free of broken windows, no holes in walls or flooring or similar defects that would contribute to the spread of smoke or fire, hallways, aisles, passageways clear of obstacles and well lighted).

Exits, Exits Lights, and Emergency Lights (unobstructed, operable, illuminated signs working properly, exit signs posted).

Electrical (approved wiring, free of splices and other defects; appropriate use of extension cords and disconnected when not in use; cords in safe operable conditions;

appliances, motors or switches free from excessive grease, lint or dust; wiring connection secured, circuits/cords not overloaded, electrical sockets, wall outlets, switches or fixtures free of defects; appliance cords free of splices or defective wiring; appliances UL or FM listed and unplugged when not in use).

Storage (18 inch clearance between supplies and light fixtures, sprinkler heads, or steam pipes; 36 inches from roof trusses or beams; inside and outside storage neatly arranged, adequate aisle spacing, 3 foot clearance from walls).

Mechanical Rooms (clean and clear of all storage).

Flammable/Combustible Materials (used and stored properly; oily waste, rags, greasy or combustible materials stored in closed metal containers and plainly identified).

Smoking Areas (designated areas; adequate number of disposal receptacles; good housekeeping practices in effect).

Posted (fire bill, evacuation plan, emergency phone number on telephones)

Coffee Mess (safely located; Timing Devices are prohibited).

Dates Inspected

Fire Warden Remarks:

Fire Warden (Name/Phone): Division Officer (Name/phone):

This Section To Be Completed By Fire Prevention Inspector Fire Drill Conducted By Fire Inspector

Time: Date: Evacuation (time in minutes): Number of Occupants:

This facility was visited by the base fire prevention inspector on:

Results:

Satisfactory Discrepancies corrected Discrepancies noted At time of inspection

Date:

Signature:

Fire Inspector Remarks:

Building Fire Warden Report (NASJAXINST 11320.2 1/15)