NYC 9/11 Public Portal Document
Instructions to Inspectors—Alt box^|^ this form must have an answer. Answe^j^ith a “NO” answers to a “V” mandate a
Violatioi^Order, “NO” answers to a mandate automatic failure. Check “YES” “NO” or “N/A”.
ON SITE EXAM FOR
FIRE SAFETY DIRECTOR—OFFICE
z 01 I nspector
Name of Candidate I - Office Address. Date of Examination
(Print last name, first i(ame)
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 and^understand English? *B. Hear spokenjwofds over a telephone? *C. Possess necessary vision?
(wit.h corjeetive devices) (corregtiye-devices acceptable)
Yes No □ Yes-0^ No □ YeSxS’^ No □
I: 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 driUx^ords current? V. B. Firem^ irvice Elevator Test Records current? v. C. Keys lu ■St Fire Command Station?
Yes 0 No □ YesPj No □0 N/A □ Yes' No □ N/A □ J
V. D. Fire Safety Plan and building floor v. E. A current lisptf all floor Wardens and phone v. F. Master window keys available?
plan at^*0Command Station? numbefs-afFire Command Station? /
Yes 0'^ No 0 Ye9*0r No □ Yes □ No □ N/A
V. G. Building current in actual Fire Drills? (*if over 3 months) YesS"^No Q
L
____________________________________________________________________________________________________ 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
A O z
Proceed.
III. a. Specific Building Inspection;
Special Instructions—Choose one floor for the general floor inspection
Building Insp^tion—Signs and Charts—
V. A. Are stajfWays properly lettered? V. B. Are floojs-pfoperly numbered? V. C. Is floor diagrat^osted?
Yes Pf No □
V. D. Are stairways re-entry
Yes.,0''^ No □
V. E. Are eleval properly lettered on each
YesJ-0NO □
V. F. Is flo00iagr^ properly oriented?
5
sign>-f5osted?
Yes 0 No □ N/A □
elevator^
No □ N/A □ Yes. No □ J
V. G. Is elevator sign “In Case of Fire, v. H. Are exit doors unlocked, closed and V. I. Fire Drill Organization Charts
Use Stajf0posted?
Yes'S No □ N/A □
unobstructed?
Ye>30 No □
postedapd-turrent?
Ye>-Ej No □
3
TOTAL (9)
III. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection
FLOOR
V. A. Are staipwgys properly lettered? v. B. Are floo[s--properly numbered? V. C. Is floor isted?
Yes J0 No □ Yes 0 No □ Yes
V. D. Are stairways re-entry V. E. Are elevatoi iperly lettered on each V. F. Is floor diagram properly oriented?
sign^zposted? elevator..' ink?
Ye>0J No □ N/A □ No □ N/A □ Yei No □
V. G. Is elevator sig n “In Case of Fire, v. H. Are exit doom unlocked, closed and V. I. Fire Drill Organization Charts
Use Stairs>Y( isted? unobshyeted? posted anp-eurrent?
Ye No □ N/A □ Yes-0I No □ YesJ<r 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
X
/
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; / \ z
NAME OF FLOOR WARDEN CONTACTED / FLOOR CHOSEN TELEPHONE NUMBER
Does Floor Warden have knowledge of: / ,
A. PositiorixfGrinq fire drill or emergency? B. Notificatop- irocedures? C. LocationgaF^ifarm boxes?
Yes-0 NO.0 Yes h )□ Yes 0 No □I N/A □ 3
D. Evacuatiprflocation?
Yes 10 No □
H. Reporting-wfiether smoke or Fire?
E. Evacu^ MYprocedures?
Yes-S'' No □
F. Numto rexits on floor?
Yes 0 No □
I. Duties of Depu^ Fire Warden and Searchers?
G. Examinini^JorOxits on floor?
YesJ3“^ No.n
V. J. WerehjB-crffITls conducted?
V
Yesjz0 No □ Yes □
■•K. Floor wardens in numerous floors properly trained?
No U
Yes-0' No □
Yes 01 No □ g
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 O Number of N/A answers iy
M25-14 16-870250-3-R2SP
NYC-WTC_000168900
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