NYC 9/11 Public Portal Document
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FORE SAFETY DIRECTOR ON SITE EXAMINATION-OFFICE
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 system
Check if is operative. If so, state why system was inoperative.
applicable
Vill. Determination of Passing:
A. If 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.
S. If the candidate satisfactorily answered the mandatory parts, but by totalling all answers, the number of NO answers were below 80%, the candidate fails
the practical test. See Chart. . . f
IX. On Site Office Building Test--(Wtnt ALL Information):
C. of F.. Z 01 No of On Site Tests ___~
/
Candidate Name I L- II
Gam/ ._ ~-- )~
c~
~ Premise Address _ , L( 1~ 4- TI=
t'
Social Security No. >. / (i '1
Date of Examination Total Number of Items Answered.
Number of correct answers are o on this test. Number of incorrect answers are . Number of N/A answers are_ _
Summary of Results:
A. PASSED nr S. FAILED--(reason)
CANDIDATE BUILDING
Those candidates failing should contact the High Rise Unit for another
appointment when building correction and%or additional knowledge is obtained.
C. Violation numbers Issued as result of examination and Inspection: D. I hereby certtify tl Ii n orrnatlon contained in this report I Beau
_
INSPE 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.
FSD-1 HIM (8/88) a-wose2-R25
NYC-WTC 000166129
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