NYC-WTC_000166105

NYC 9/11 Public Portal Document

nstructions to Inspectors—All boxet n this form must have an answer. AnsweL .pith a "NO" answers to a "V" mandate a Violation Order, "NO" answers to a "" mandate automatic failure. Check "YES" "NO" or "N/A". ON SITE EXAM FOR FIRE SAFETY_ DIRECTOR-OFFICE Z 01 _________PII_________ Inspector JQr~ ('' L4/ 1 C Name of Candidate_ Office Address Date of Examination (Print last name, first name) A: !cv`1! ' )_1 Instructions to Inspectors-4f any asterisk (*) items are marked "NO", terminate the test immediately. See Section Vlll for YES NO N/A further information. 1. Physical Requirements—Does candidate have ability to: *A. Speak and understand English? *B. Hear spoken words over a telephone? I C. Possess necessary vision? (with rective devices) j (corrective devices acceptable) Yes_ No ❑ Y No ❑ J Yes No El B: Building In=ctions to Inspector—If any violation (V) Items are marked "NO", issue a Violation Order at the end of the Test. Test must proceed. 11. v. A. Fire do ords current? v. B. Firemen's Service Eleva r est ecor s current? v. C. Keys kept at Fire Cpniinand Station. Yes El N Yes El No El N/A Yes El N 1 N/A El v. D. Fire Safety Plan an wilding flood v. E. A current list II 1 r ns and phon v. F. er window keys available? plan at Fire Command ion? j numbers at Fl otn an Lion? 3 Yes El No — Yes❑ No Yes [Ti No El NIA El v. G. Building current in actual Fire Drills. *if over 3 months) Yes ❑ TOTAL (7) Instructions to Inspector—if any violation (V) Items are rked " ",issue a Violation Order at the end of the Test. Test must Proceed. Ill. a. Specific Building Inspection: Special instructions—Choose one floor for t eneral floor insp FLOOR Building Inspection—Signs and Cha i v. A. Are stairwaysproperly lettered v. B. Are floors p pe um r ? v. C. Is floor diagram sted? -Yes ❑ No Yes ❑ N ❑ Yes ❑ No ❑ O v. D. Are stairways re-e v. E. Are elevators properly let e h v. F. Is fIoor isgam properly oriented? posted? elevator bank? YesSi N N/A El Yes No N/A El Yes El No El v. G. ls ie tor sign "In Case of Fire, v. H. Are exit doors unlocked, closed and v. I. Fire Drill Organizatl Charts se Stairs" posted? unobstructed? posted and current? Yes El No El N/A El Yes No❑ Yes 0 No El r TOTAL (9) Ill. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection FLOOR v. A. Are stairways properly lettered? v. B. Are floors properly numbered? v. C. Is floor diagram posted? Yes. No ❑ Yes No ❑ Ye No ❑ v. D. Are stairways re-entry v. E. Are elevators properly lettered on each v. F. Is floor diagram properly oriented? Si 11 sted? elevator bank? Yes 1 No ❑ N/A ❑ Yeses No El N/A ❑ Yes No ❑ v. G. Is elevator sign "In Case of Fire, J v. H. Are exit doors unlocked, closed and v. I. Fire Drill Organization Charts Use Stairs" posted? Yes No ❑ N/A O unobstructed? Yes ' No ❑ posted and current? Yes No El 3 TOTAL (9) IV. Instructions to Inspector—If tour (4) or more Items below are marked "NO", the inspector must issue a Violation Order at the end of the test. Test must proceed. This next part must proceed with contacting a Floor Warden within the Building. Read the following statement to the Warden—'In the event eta fire on this floor, explain which specific actions must be taken by ou." FLOOR WARDENS: ( t p- 1K~- NAME OF FL OR WARDEN CONTACTED FLOOR CHOSEN TELEPHONE NUMBER Does Floor Warden have knowledge of: A. Positj4tJrin fire drill or emergency? B. Notificatio procedures? C. Location o alarm boxes? Yes- No~ YeJ,d No ❑ Yes No Q N/A ❑ D. Evacuation location? E. Evacuation procedures? 1 F. Number of exits on floor? G. Examining for exits on floor? Yes, No ❑ Yes No ❑ Yes No ❑ L Yes. No ❑ H. Reporti whether smoke or Fire? I. Duties of Depu Fire Warden and Searchers? v. J. Were fi rills conducted? Yes No ❑ — Yes,.' No 8 Yes No ❑ 3 *K. Floor wardens in numerous floors properly trained? Yes,2 No ❑ TOTAL (11) Section B: (11, III, IV) 8 or more answered "NO" in Section B falls. SECTION B TOTAL (36) Number of correct answers in this section is . Number of incorrect answers is .~ . Number of N/A answers is M25.14 1&87025O<l1125P

NYC-WTC 000166118