NYC-WTC_000166105

NYC 9/11 Public Portal Document

Instructions to inspectors—All boxes . this form must have an answer. Answers h a "NO" answers to a "V" mandate a Violation Order, "NO" answers to a "" mandate autocratic failure. Check "YES" "NO" or "N/A". ON SITE EXAM FOR FIRE SAFETY DIRECTOR-OFFICE ,Z 01 t.S '- S 1 e 't Inspector ®t t`^ ~Jr.s __-__Y

Name of Candidate .J'ArMtLS '-I Office Address -~O( t 'mot . Date of Examination _0 -it -4 S (Print last name, first name) ty ~-1 L ha I a L; . A: Instructions to Inspectors—If any asterisk (*) Items are marked "NO", terminate the test immediately. See Section VIII 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? *C. Possess necessary vision? (withgpective devices) (correctjy devices acceptable) Yes No O Yes L"1 No ❑ Yes 1f 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. I1. Records: t2-tS -`r`l v. A. Fire ,drip records current? v. B. Firem pis Service Elevator Test Records current?l v. C. Keysjpt at Fire Command Station Yes No ❑ Yes 1-1 No ❑ N/A O Yes No ❑ N/A ❑ 3 v. D. Fire Safety Plan and building fioo v. E. A current list of all floor Wardens and phonel v. F. Master window keys available? plan at re Command Station? num,ps at Fire Command Station? - — Yes ~ No O Yes 9 No ❑ Yes ❑ No n N/A v. G. Building current in actual Fire Drills? *if over 3 months) Yes ' No O — — TOTAL (7) 4) Instructions to inspector—If any violation (V) Items are marked "NO", Issue a Violation Order at the end of the Test. Test must Proceed. Ill. a. Specific Building Inspection: Special Instructions--Choose one floor for the general floor inspection _3 `( FLOOR Building Inspection—Signs and Charts— v. A. Are sta'jPways properly lettered? v. B. Are fl9r properly numbered? v. C. Is floor jc iagram pasted? 3 _ — Yes L No Yes L1 No ❑ Yes No ❑ v. D. Are stairways re-entry v. E. Are elevators properly lettered on each v. F. Is floor diagram properly oriented? Sis s posted? elevator ank? 3 — — Yes No N/A❑ Yes L1 No❑ N/A❑ Yes No v. G. Is elevator sign "In Case of Fire, v. H. Are exit doors unlocked, closed and v. I. Fire Drill Organization Charts Use St ifs-' posted? unobstr ed? posted 9nd current? 3 — — Yes ONo❑ N/A❑ Yes No U Yes LNo❑ TOTAL (9) Cl

Ill. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection FLOOR v. A. Are staff ways properly lettered? v. B. Aref~lp(qr$ properly numbered? v. C. Is floor diagram posted? Yes L1 No❑ Yes E NoL Yes L7 No [I •3 v. D. Are stairways re-entry V. E. Are elevators properly lettered on each v. F. Is floor diagram properly oriented? Si9nss sled? elevator bank? J — YesLT No O N/A❑ Yes No N/A❑ Yes No v. G. is elevator sign "in Case of Fire, v. H. Are exit doors unlocked, closed and v. I. Fire Drill Organization Charts Use ,Sttai - posted? unobst cted? posted d current? 3 — — Yes L3 No N/A 0 Yes L1 No Yes 9' No El TOTAL (9) IV. Instructions to Inspector—If four (4) or more items below am 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 WARDENS: (;CLLJ,.1:' J t r1t l 1 NAME OF FLOOR WARDEN CONTACTED FLOOR CHOSEN TELEPHONE NUMBER Does Floor Warden have knowledge of: A. Positio durin fire drill or emergency? B. Notification procedures? C. Location of alarm boxes? — Yes l No~ Yes 7 No Q Yes Q No ❑ N/A ❑ D. Evacua 'on location? E. Evacuat' n procedures? F. Numbs of exits on floor? G. Examining for exits on floor? Yes a No Yes 1 No O Yes9 No Yes El' No❑ H. Repo,rrupg whether smoke or Fire? I. Duties_gf Depu Fire Warden and Searchers? v. J. Were. file drills conducted? 3 — Yes L No Yes 1f No Yes[' No❑ *K. Floor wardens in numerous floors properly trained? Yes Q J No ❑ 1 — TOTAL (11) i 1 Section 8: (11, 111, IV) 8 or more answered "NO" In Section B fails. SECTION B TOTAL (36) Number of correct answers in this section is 3 lc . Number of incorrect answers is 4 . Number of N/A answers is

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NYC-WTC 000166161