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Building Safety Checklist Form
Safety Checklist
Date
*
MM slash DD slash YYYY
Supervisor
*
Cariota
Adam
Jackson
Parks
Other
Location
*
Bender HQ
Station 91
Station 92
Station 93
Station 94
Station 95
Station 96
General Conditions
YES
NO
1. Are walking surfaces clean, clear of debris, and dry?
2. Are stairs, steps, handrails, and landings in good condition?
3. Is the area lighting adequate?
4. Is general housekeeping acceptable and storage neat and orderly?
5. Is furniture in a good state of repair?
General Conditions Comments
Building Evacuation and Life Safety
YES
NO
1. Are exits properly identified and lighted?
2. Are exit paths clear?
3. Are exit doors operable and equipped with panic hardware?
4. Is emergency lighting operable?
5. Does the fire alarm work?
6. Are evacuation floor plans posted?
7. Are emergency phone numbers posted in conspicuous areas throughout the building?
Building Evacuation and Life Safety Comments
Fire Prevention
YES
NO
1. Are portable fire extinguishers available?
2. Are extinguishers serviced/tagged annually?
3. If sprinkler, is it operable and tested regularly?
4. Do smoke, heat & other detection alarm systems work?
5. Is the No Smoking policy enforced in buildings and vehicles?
6. Are combustibles and trash controlled?
7. Are flammables properly stored in cabinets?
8. Is there evidence of electrical wire overheating?
9. Has an electrician inspected the wiring?
10. Are multiple plug outlets and use of extension cords kept to a minumum?
11. Are portable heating devices UL-listed?
Fire Prevention Comments
Ktichen Fire Prevention
YES
NO
1. Is there a cooking ventilation system?
2. Are cooking filters clean with no grease buildup?
3. (if available) Does a dry chemical fire suppression system protect cooking surfaces and deep fryers?
4. (if available) Is dry chemical fire suppression system available and inspected regularly?
5. Are deep fat fryers equipped with thermostats and high temperature control?
6. Is there a 10-pound dry chemical fire extinguisher in the immediate cookign area?
Kitchen Fire Prevention Comments
Boilers and Heating Equipment
YES
NO
1. Are boilers and water heaters services regularly?
2. Are state inspection certificates on file and current?
3. Is there any water/steam/fuel leakage noted?
4. Is there are PM service contract for heating and AC equipment?
Boilers and Heating Equipment Comments
Outside Grounds
YES
NO
1. Is the parking area well maintained?
2. Are exterior walkways in good condition?
3. Is exterior illumination adequate?
4. Are all lights functional?
5. Is signage adequate and properly secured?
Outside Grounds Comments
Other Pertinent Information
Supervisor Email
Phone
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