NYC 9/11 Public Portal Document
FIRE DIRECTOR ON SITE EXAMINATK^-OFFICE
iectlon D;__________________________ ___________________________________________________ __ _______________
/II. 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 -------------------- --------------------- ---------------------------------------------------------------------------------------------------------------------------------- -—
Zill. Determination of Paasing:
If the candidate failed to answer satisfactorily the essential questions marked (*), advise the candidate that a new appointment shbuld be requested by
contacting the High Rise Unit. The examiner should also give the applicant a bill for the inspections/examination. *
3. 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.
IX. On Sits Office Building Test—(Print ALL Information);
C. ofF. Z 01 No. of On Site Tests
Candidate Name
Premise Address r -
A?/
Social Security No.
IT” '■ Pii L
Total Number of Items Answered
□ate of Examination
Number of correct answers are.
A Cf
' on this tost. Number of incorrect answers are . Number of N/A answers are ZA
Summary of Results:
or B. FAILED—(reason)
A. PASSED
(CHECK)
CANDIDATE BUILDING
Those candidates failing should contact the High Rise Unit for another
appointrnem when building correction and/or additional knowledge is obtained.
C Violation numbers Issued ss result of examination and inspection: D. I hereby certify all information contained in thia report ia accurate.
cT inspector
______ 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.
3-1 H/M (8/86) 2.8706654126
NYC-WTC_000168869
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