NYC-WTC_000166105

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FIRE SAFETY DIRECTOR ON SITE EXAMINATION`-OFFJCE Section D: VII. Comments by Examiner: ( ) The Class E system was inoperative, candidate was advised to send in an affidavit indicating proper instruction has been provided and s}s:ern Check it is operative. If so. state why system was inoperative. applicable

VIII. Determination of Passing: A. It the candidate failed to answer satisfactorily the essential questions marked ('), advise the candidate that a new appointment should be requested by contacting the High Rise Unit. The examiner should also give the applicant a bill for the inspections/examination. Q If the candidate satisfactorily answered the mandatory parts, but by totalling all answers, the number of NO answers were below 80%. the candSate ;ails the practical test. See Chart. - IX. On Site High Rise Test.—(Print ALL information): C. of F. Z 01 _ No. of On Site Tests

Candidate Name _ ,, . .~._._ _._._._._._._._._._:_:_ __._._ Office Address ~ _

Social Security No. ---_.-._.-_._._._-.PLL_._-_._._._._._._._._._._._._._._._._. c -i _

Date of Examination Total Nq~ber of Items Answered

Number of correct answers are on this test. Number of incorrect answers are _ . Number of N/A answers are,-

Summary of Results: A. PASSED or a FAILED—{reason) (CHECK)

CANDICATE - BUILDING Those candidates failing should ccntac: the High Rise Unit for another e appointment when building ccrretrion-andtcr additional knowledge is cctair.ec. C. Violation numbers Issued as result of examination and inspection: O. 1• hereby certify all Information contained In this report is accurate.

INSPECTOR DATE

White copy must be given to the Candidate. Canary copy must be submitted to the High Rise Unit. INSPECTORS ARE ONLY PERMITTED TO PROVIDE CANDIDATES WITH Pink copy must be submitted to Cashier's office. SECTION D.

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NYC-WTC 000166304