NYC 9/11 Public Portal Document
Instructions to Inspectors—All boxes^ftthis form must have an answer. Answers^^ 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
FIRE SAFETY DIRECTOR—OFFICE
Inspector—
Name of Candidate.
(Print last name, fifst name)
Office Address. 744 Date of Examination.
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 andI understand English? * B. Hear spoken^ords over a telephone? *C. Possess necpssary vision?
3
(with corredtive devices) (correctiye^vices acceptable)
Yes No □ Yes No □ Yes U No □
: 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 dj^records current? V. B. Firemen^ Service Elevator Test Records current?! V. C. Keys5 kenkSt Fire Command Station?
Yes 0 No Q Yes □/ No □ N/A □ Yes No □ N/A □
V. D. Fire Safety Plan and building floor V. E. A current list of all floor Wardens and phone V. F. Master window keys available?
3
plan attire Command Station? numberaXf Fire Command Station?
Yes 0 No □ Yes No □ Yes □ No □ N/Ai
V. G. Building current in actual Fire Drills? pygr 3 months) No □
____________________________________________________________________________________________________ TOTAL]?)
J-
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 Inaction—Signs and Charts—
V. A. AresUifways properly lettered? V. B. Al properly numbered? V. C. Is flog^agramposted?
YesTJ □ No □ Yes-O JJo □
V. E. Are inters properly lettered on each V. F. Is floor dii properly oriented?
V. D. Are ! ttnrways re-entry
Yes/Q
V. G. Is el
posted^
No N/A □
|dr sign “In Case of Fire,
elaV itor bank?
□ No □
V. H. Are
N/aJ>
unlocked, closed and
Yes No □
I. Fire Drill Organization Charts
5
Use tirs" posted? unj —tructed? posted andxurrent?
Yes' No □ N/A □ □ No □ Yes No □
TOTAL (9)
III. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection
Floor
V. A. Are properly lettered? V. B. Are properly numbered? V. C. Is floor diagfdfri posted?
Yes V^NoQ No □ YesJJ^o □
V. D. Are lairways re-entry V. E. Are eh ators properly lettered on each V. F. Is floor dii properly oriented?
posted? bank?
Yes □ No P N/A □ Yes □
No □ N/A P fpsTj No □
V. G. Is elevatdf sign “In Case of Fire, V. H. Are exit 5ors unlocked, closed and V. I. Fire Drill Org^ization Charts
Use^rs” posted? unob^ ed? posted an0.^rrent?
YeslJ No □ N/A □ Yes/Q No □ YesjXMo □
___________________________________________________ _____________________________ ____________________ 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:
NAME OF FLOOR WARDEN COI ;d floor chosen TELEPHONE NUMBER
Does Floor Warden have knowledge of:
A. Position durtfig fire drill or emergency? B. Notificatierr procedures? C. Locatiop.ef^Slarm boxes?
Yes No □ Ybs-HT h Yes □ No □ N/A □
D. Evacu^ nocation?
Yes No □
H. Report whether smoke or Fire?
E. Evaci
Yes'!
jrfprocedures?
No □
F. Number>er§xits on floor?
Yes No □
I. Duties oL-B6wtv Fire Warden and Searchers?
G. Exarniniog4or exits on floor?
Yes'Ll No □
V. J. Were fire drills conducted?
T
YesS'”^ No □ YerO No □ _ _ Yee^B^Mo □
*K. Floor wardens in numerous floors properly trained? YedlZ] No D
TOTAL (11)
Section B: (II, III, 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-M 16.870250-3.B25-P
NYC-WTC_000168836
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