NYC-WTC_000166105

NYC 9/11 Public Portal Document

Instructions to Inspectors—All boxes this form must have an answer. Answers .th a "NO" answers to a "V" mandate a Violation order, "NO" answers to a " a " mandate automatic failure. Check "YES" "NO" er "N/A". ON SITE EXAM FOR FIRE SAFETY DIFECTOR= OF ICE z 01 Inspector l~f_'

Name of Candidate Office Address Lisp Date of Examination •Pint last name, name) A: — -- T Instructions to inspectors—If any asterisk (*) Items are marked "NO', terminate the test immediately. See Section VIII for YES NO ' N/A further information. I. Physical Requirements—Does candidate have ability to: _ *A. Speak and j.mderstand English? B. Hear spoke .words over a telephone? *C. Possess necessary vision? (with coetive devices) (correecctl evices acceptable) Yes No ❑ Yes ❑ Yes t1 No ❑ B: Building Instructions to Inspector—if any violation (V) Items are marked "NO", Issue a Violation Order at the end of the Test. Test must proceed. II. Records: v. A. Fire drijYrecords current? v. B. Firemen' ervice Elevator Test Records current? v. C. Keys ke t Fire Command Station. Yes No ❑ Yes No El N/A ❑ Yes LLY No ❑ N/A ❑ v. D. Fire Safqt9 Plan and building floo v. E. A current list of all floor Wardens and phone v. F. Master window keys available? plan a ire Command Station? number34t Fire Command Station? Yes l,LI No El Yes lY No ❑ _ Yes❑ No ❑ N/A v. G. Building current in actual Fire Drills? (*if over 3 months) Ye No ❑ TOTAL (7) ILIl Instructions to Inspector--If any violation (V) items are marked "NO", Issue a Violation Order at the end of the Test. Test must Proceed. -1 III. a. Specific Building Inspection: Special Instructions—Choose one floor for the general floor inspection Building in ection—Signs and Charts— FLOOR v. A. Are mays properly lettered? v. B. Are rs properly numbered? J v. C. Is flo iagram osted? Yes (J [~ es No El Yes No v. D. Si Ares rways re-entry v. E. Are gJeàtors properly lettered on each v. F. Is floor dia m properly oriented? sp posted? el ator bank? Yes No N/A ❑ Ses ❑ No ❑ N/A Yes No ❑ v. G. Is elev r sign "In Case of Fire, v. H. Are e ' oors unlocked, closed and . I. Fire Drill Orgafization Charts Use airs" posted? un structed? posted an current? Yes❑ No El N/A El • s El No El Yes No El _ TOTAL (9) Ill. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection _ FLOOR v. A. Ares iq4ays properly lettered? v. B. Aro}pi properly numbered? v. C. Is floor dia m posted? Yes No ❑ ) tJ No ❑ Yes No ❑ v. D. Are airways re-entry v. E. Are eleat6rs properly lettered on each v. F. Is floor dia properly oriented? Si S posted? eIevldr bank? Yes No N/A ❑ Yes ❑ No ❑ N/A Y No ❑ v. G. Is elev r sign "In Case of Fire, v. H. Are exit ors unlocked, closed and v. I. Fire Drill Org ization Charts Use airs" posted? unob ctod? posted an urrent? Yes No ❑ N/A ❑ Yes No ❑ Yes No ❑ TOTAL (9) IV. Instructions to Inspector—If four (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 of a fire on this floor, explain which specific actions must be taken by you:' FLOOR ENS: 4/ NAME OF FLOOR WARDEN CO TED FLOOR CHOSEN TELEPHONE NUMBER Does Floor Warden have knowled a of: A. Position jarfn fire drill or emergency? B. Notif ,3tiaer procedures? C. Loca D- -BTarm boxes? YesLd' No js J No❑ YesLI No❑ N/A❑ D. Evacuati ocation? _E.Eva ioT1"rocedures? F. Number exits on floor? G. Examsi or exits on floor? Yes No ❑ Yes LI No ❑ Yes U No ❑ Yes LJ No ❑___ H. Reportin ether smoke or Fire? 1. Duties epuxt Fire Warden and Searchers? v. J. Were fire drills conducted? Yes No ❑ Ye No L__I Yes- " —No ❑ *K. Floor wardens in numerous floors properly trained? Y No ❑ TOTAL (11) Section B: (II, 111, IV) 8 or more answered "NO" in Section B fails. 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&H10250.3•R25•P

NYC-WTC 000166319