SOP 511.03-att-1: Fire and Life Safety Inspection Report

SOP 511.03
Attachment 1

9/6/18
Page 1 of 5

INSTITUTION: ___________________________________

FIRE & LIFE SAFETY INSPECTION REPORT

FOR THE MONTH OF: ________________

Name of Building: __________________________________ Date: __________________

Certificate of Occupancy No. _________________________ Time: __________________

Person in Charge: ________________________________________________________________

The contents of this report outline conditions that may cause a fire or create a hazard to life or
property in the event of fire. Your prompt and complete cooperation will be appreciated.

DEFICIENCIES OR
I. EVACUATION CORRECTIVE ACTION

A. EVACUATION PLAN
1. Evacuation plan posted?
Yes No Non-existent ___

2. Officer familiar with plan?

3. Inmates/residents familiar
with plan?
Yes No__

4. Communication system from
living area to control room:
Working Out-of-order__
Non-existent__

5. Date of last fire drill:
/ /

6. Fire drills up-to-date?
Yes No _

B. PHYSICAL ENVIRONMENT
1. Exit lights:
Working Out-of-order __

Non-existent __

2. Emergency lights:
Working Out-of-order__
Non-existent__

Retention Schedule: Upon completion, this report shall be maintained until resolution of any discrepancies, kept for
(five) 5 years after that, and then destroyed. The official copy shall be maintained at the office of Fire Services and
Life Safety.

SOP 511.03
Attachment 1

9/6/18
Page 2 of 5

DEFICIENCIES OR
3. Exit way (hall/passageway): CORRECTIVE ACTION
Clear Blocked__

C. EGRESS
1. Immediate living area
(cell, rooms, dormitory)

a. Condition of keys:
Good Poor__

b. Condition of locks:
Good Poor__

c. Color-coded to locks:
Yes No__

d. Doors:
Clear Blocked__

e. Doors work properly?
Yes No__

2. Exits to outside:
a. Lead to secure, fire/smoke
safe area?
Yes No__

b. Number of doors or gates: ___________

c. Condition of keys:
Good Poor __

d. Condition of locks:
Good Poor __

e. Door(s):
Clear __ Blocked__

3. Stairwells:
a. Condition:
Good Poor__

4. Emergency Keys:
a. Available for all exits?

DEFICIENCIES OR

Retention Schedule: Upon completion, this report shall be maintained until resolution of any discrepancies, kept for
(five) 5 years after that, and then destroyed. The official copy shall be maintained at the office of Fire Services and
Life Safety.

SOP 511.03
Attachment 1

9/6/18
Page 3 of 5

Yes No __ CORRECTIVE ACTION
b. Condition:
Good Poor__

c. Kept in central location?
Yes No __

d. Keys color-coded to locks?
Yes No__

II. EMERGENCY EQUIPMENT

A. DETECTION
1. Smoke detections:
Working Out-of-order __
Non-existent __

2. Fire-alarm system:
Working Out-of-order__
Non-existent __

3. Other:
Working Out-of-order__
Non-existent __

B. FIREFIGHTING
1. Fire extinguisher:
a. Number:
b. Type:
c. Properly located:
Yes No __
d. Condition:
Functional: ______
Expended: _______
Recharge date: __

2. Hose line:
a. Available__
Unavailable__

b. Date of last inspection: _______

3. Automatic sprinkler systems:
a. Working ___

DEFICIENCIES OR
CORRECTIVE ACTION

Retention Schedule: Upon completion, this report shall be maintained until resolution of any discrepancies, kept for
(five) 5 years after that, and then destroyed. The official copy shall be maintained at the office of Fire Services and
Life Safety.

SOP 511.03
Attachment 1

9/6/18
Page 4 of 5

Out-of-order___
Non-existent ___

b. Post indicator valve open?
Yes No__

c. Siamese connection:
Clear Blocked__

4. Other - identify and
describe condition
______________
_______________
_______________

III. LIVING AREA

A. ELECTRICAL
1. Wall sockets:
Safe Unsafe__
Non-existent__

2. Electrical fixtures:
Safe Unsafe__
Non-existent__

3. Wiring:
Permanent:
Safe Unsafe__
Extension cords:
Safe Unsafe___
Non-existent

B. HOUSEKEEPING
1. General:
a. Overall cleanliness:
Satisfactory__
Unsatisfactory

b. Overall orderliness:
Satisfactory __
Unsatisfactory __

DEFICIENCIES OR
CORRECTIVE ACTION
2. Accumulation of

Retention Schedule: Upon completion, this report shall be maintained until resolution of any discrepancies, kept for
(five) 5 years after that, and then destroyed. The official copy shall be maintained at the office of Fire Services and
Life Safety.

SOP 511.03
Attachment 1

9/6/18
Page 5 of 5

combustibles?
Yes No __
Explain ________________

2. Bedding:
a. Approved?
Yes No__
b. Condition:
Satisfactory__
Unsatisfactory__

3. Personal storage area:
a. Condition:
Satisfactory__
Unsatisfactory __

4. Trash receptacles:
a. Approved?
Yes No __
b. Condition:
Satisfactory__
Unsatisfactory__

5. Heating system:
a. Condition:
Good __
Needs maintenance __

6. Cooling/ventilation system:
a. Condition:
Good __
Needs maintenance __

Notes: __________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Facility Inspector: ________________________ Date:

Warden: _______________________________ Date:

Retention Schedule: Upon completion, this report shall be maintained until resolution of any discrepancies, kept for
(five) 5 years after that, and then destroyed. The official copy shall be maintained at the office of Fire Services and
Life Safety.