NYC-WTC_000166105

NYC 9/11 Public Portal Document

Instructions to Inspectors—All boxeb on this form must have an answer. Answers with 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 01 FIRE SAFETY DIRECTOR- FIC Z Inspector ~• ~l Name of Candidate Office Address Date of Examination v Told.1 , 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 I. Physical Requirements—Does candidate have ability to: *A. Speak and understand English? I B. Hear spoken words over a telephone? C. Possess n essary vision? I (with ive devices) (corn devices acceptable) Yes 91 Nc❑ Yes No Yes 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. 11. Records: v. A. Fire drill records current? v. B. Firemen's Service Elevator Test Records current? v. C. Keys kept at Fire Command Station. Yes❑ No❑ Yes❑ No❑ N/A❑ Yes No❑ N/A❑ v. D. Fire Safety Plan and building floc v. E. A current list of all floor Wardens and phone v. F. Master window keys available? plan at Fire Command Station? numbers at Fire Command Station? Yes❑ No❑ Yes❑ No❑ j Yes❑ No 0 N/A❑ v. G. Building current in actual Fire Drills? *. over 3 months) Yes ❑ No ❑ TOTAL (7) Instructions to Inspector—If any violation (V) items are marked "NO", issue a Violation Order at the end of the Test. Test must Proceed. III. a. Specific Building Inspection: Special Instructions—Choose one floor for the general floor inspection FLOOR Building Inspection—Signs and Charts— v. A. Are irways roperly lettered? v. B. Are fl rs properly numbered? v. C. Is floor gram°sled? Yes No r, Yes No ❑ Yes ZNo LJ v. D. Are tairways re-entry v. E. Are el ors properly lettered on each v. F. Is floor diagram properly oriented? si posted? elevato ark? YesVJ No ❑ N/A ❑ Yes No ❑ N/A ❑ Yes LNo ❑ v. G. Is elevator sign "in Case of Fire, v. H. Are exit doors unlocked, closed and v. I. Fire Drill Organization Charts Use S irs" posted? unobstr ed? posted.pid current? Yes J No ❑ N/A ❑ Yes No ❑ Yes J No ❑ TOTAL (9) III. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection OOR v. A. Are ys properly lettered? v. B. Are f s properly numbered? v. C. Is fioo iagram posted? Yes No ❑ Yes No ❑ 'Yes No ❑ v. D. Are stairways re-entry v. E. Are eIevt6rs properly lettered on each Tv. F. Is floor gaagram properly oriented? si posted? elevate 'bank? Yes No ❑ N/A ❑ v. G. Is elevat sign "In Case of Fire, Yes No ❑ N/A ❑ Yes No ❑ v. H. Are exitAoors unlocked, closed and v. I. Fire Drill rganization Charts 3 Use S rs" posted? unob cted? posted nd current? Yes No ❑ N/A ❑ Yes 11 No ❑ Yes VJ 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 WARDEN-O C~ 4i n / Z NAME OF FLOOR WARCEN CONTACTED FLOOR CHOSEN TELEPHONE NUMBER Does Floor W rden have knowledge of: A. Posit/9 urin fire drill or emergency? B. Notifi ion procedures? C. Locati of alarm boxes? Yes Noff YesljJ No ❑ I Yeslli No ❑ N/A ❑ D. Evacua' location? E. Evacuat' n procedures? F. Num of exits on floor? G. Exami ' g for exits on floor? Yes No ❑ Yes N ❑ Yes No ❑ Yes No [1 H. Re ortin whether smoke or Fire? I. Duties f Depu Fire Warden and Searchers? v. J. Were e drills conducted? Yes No ❑ Yes No Yes J No U] *K. Floor wardens in numerous floors properly trained? Yes No ❑ i TOTAL (11) Section B: (1{, N{, IV) 8 or tno a Bred "NO" in Section 8 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 16.870250-3-m5-P

NYC-WTC 000166140