Smoke Barrier INSP Form.pdf

PDF 510 KB Posted

Attached to
H156--Site Visit Questions and Answers| WNY Chute, Barrier, & Door Inspections
Solicitation number
36C24226Q0687
Issued by

About this file

This document is a Smoke Barrier/Door Preventive Maintenance Inspection Form used to assess the compliance and integrity of smoke barriers and smoke doors at a facility.

The inspection form contains two primary checklists: a Smoke Barrier Inspection Checklist and a Smoke Door Inspection Checklist. The Smoke Barrier section requires inspectors to verify the visual presence of smoke barriers, confirm that adjoining rooms have visible fire barriers, and ensure the identified smoke barrier meets 100% completion with no through penetrations. The note clarifies that 100% completion means one side of the smoke barrier is completely intact with no penetrations, and specifies that wing entrances containing cable trays for data and electrical lines must use fire-rated pillows to complete the smoke barrier. The Smoke Door section requires inspectors to confirm door presence, verify that door lites have no damage, ensure doors resist passage of smoke with gaps less than ¾" undercut and less than ¼" at jambs and header, and confirm doors close properly. The form includes fields for the inspector to document facility, building, floor, location, signature, and overall compliance status (yes/no). If non-compliant, inspectors must provide a description of failures, document any repairs made, and record the date repairs were completed and the party responsible. Upon completion, all inspection forms must be returned to the Carpenter Shop Supervisor for verification and upload.

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Text version

SMOKE BARRIER/DOOR PM’S INSPECTION FORM

FACILITY: BUILDING:

FLOOR: LOCATION:

INSPECTOR: SIGNATURE:

DATE: COMPLIANT ⃝ YES ⃝ NO

(IF NOT COMPLIANT FILL OUT DESCRIPSTION)

PASS FAIL N/A

⃝ ⃝ ⃝ Visual confirmation that smoke barrier is present.

⃝ ⃝ ⃝ Adjoining rooms have visible fire barrier.

Adjoining room(s) ID ___________

⃝ ⃝ ⃝ Identified smoke barrier meets 100% completion (No through penetration)

PASS FAIL N/A

⃝ ⃝ ⃝ Door Present ⃝ ⃝ ⃝ Door lite is has no damage

⃝ ⃝ ⃝ Door resist passage of smoke ⃝ ⃝ ⃝ Door closes properly (Gaps are less than ¾” undercut and less than ¼” at jambs and header)

DESCRIPTION OF FAILURES:

Repairs Made:

DATE REPAIRS WERE COMPLETED:

REPAIRS COMPLETED BY:

ONCE COMPLETED

ALL INSPECTION FORMS MUST BE RETURNED TO

CARPENTER SHOP SUPERVISOR

FOR VERIFICATION AND UPLOAD

SMOKE BARRIER INSPECTION CHECKLIST

NOTE:

100% indicates that ONE side of Smoke Barrier is completely intact with no penetrations

Wing entrances may contain cable tray used for data, and electrical lines. If this is applicable to the inspected smoke barrier, ensure fire rated pillow is used to completed smoke barrier.

SMOKE DOOR INSPECTION CHECKLIST

File details come from the government source that posted it. Updated .