NYC-WTC_000166105

NYC 9/11 Public Portal Document

Instructions to Inspectors--►. ooze .i this form must have an answer. iwe, 'Ith a "NO" answers to a "V" mandate a Violation Order, "NO" answers to a " a " mandate automatic failure. Check "YES" "NO" or "N/A". ON SITE EXAM FOR FIRE SAFETY DIRECTOR-OFFICE Z 01 6 t3 b L 9 Inspector

Name of Candidate_L -C 4 N &h 1 E} Q ( Office Address amination t( -. . (Print last name, first name) A: Instructions to Inspectors—If any asterisk (') Items are marked "NO", terminate the test Immediately. See Section Vill for YES NO N/A further information. I. Physical Re uirements—Does candidate have ability to: A. apd understand English? I 'B. Hear spoken words over a telephone? *C. Possess necessary vision? (with c rrective devices) (corr ive devices acceptable) Spe]ZN o ❑ Yes Yes No ❑ Yes No ❑ B. BulldirLá 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 rill records current? v. B. Fireme s Service Elevator Test Records current? v. C. Ke pt at Fire Command Station Yes L7 No ❑ Yes No ❑ N/A ❑ Yes No ❑ NIA ❑ v. D. Fire afety Plan and building floo v. E. A current list of all floor Wardens and phonej v. F. Master window keys available? plan at Fre Command Station? nurfl at Fire Command Station? Yes No ❑ Yes 1 No ❑ Yes ❑ No ❑ N/A v. G. Buildin current in actual Fire Drills? 'if ov 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. Ill. a. Specific Building Inspection: Special Instructions—Choose one floor for the general floor inspection F O0R Building Inspection—Signs and Charts— v. A. Are irways roperly lettered? v. B. Are floors properly numbered? v. C. Is floor diagram sted? Yft No Yes J No ❑ Yes ❑ No v. D. Are stairways re-entry v. E. Are elevators properly lettered on each v. F. Is floor diagram properly oriented? s n posted? elevator bank? Yes No ❑ N/A ❑ Yes ❑ No N/A ❑ Yes ❑ No v. G. Is levator sign "In Case of Fire, v. H. Ath exit doors unlocked, closed and v. 1. Fire Drill Organization Charts Use Stairs' poste? unobstructed? poste and current? Yes ❑ No N/A ❑ Yes ❑ No ❑ Yes N No ❑ I~ TOTAL (9) Ill. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection FctOR v. A. Are airways properly lettered? v. B. Are floors properly numbered? v. C. Is floo diagram posted? Yes No Li YesN No❑ Yes JL No LI v. D. Arestairways re-entry v. E. Are elevators properly lettered on each v. F Is floor di gram properly oriented? ag posted? el for bank? Yes No ❑ N/A ❑ Yes No ❑ N/A ❑ YesL. No ❑ v. G. Is Ievator sign "In Case of Fire, v. H. Are exit doors unlocked, closed and v./. Fire Drill Organization Charts Use airs" posted? un cted'. posted and current? Yes ttL 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 proceedwith 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 FLOOR WARDENS:

NAME OF FLOOR DEN CO D FLOOR CHOSEN TELEPHONE NUMBER Does Floor Warden have knowled of: A. os i durin fire drill or emerg cy? B. Notify tion procedures? C. Locati n of alarm boxes? Yes No~ Yes No ❑ Yes I7 No ❑ NIA ❑ D. Evacbtion location? E. Ev u tion procedures? F. Number of exits on floor? . Exa it ng for exits on floor? Yes L No ❑ Yos'J No ❑ I Yes No ❑ Yes No ❑ >C H. Repojng whether smoke or Fire? . Dutie of Depu Fire Warden and Searchers? v. J. We re drills conducted? Yes No ❑ Yes L3 No D Yes 4 No ❑ *K. Floor wardens in numerous floors properly trained? Yes No ❑ TOTAL (11) Section B: (II, 111, IV) 8 or moe answered " O" in Section B fails. SECTION B TOTAL (36) Number of correct answers in this section is . Number of incorrect answers is Cf . Number of N/A answers is -- r 10544 16 250.35254'

NYC-WTC 000166184