NYC 9/11 Public Portal Document
Instructions to Inspectors—All boxH^n this fond must have an answer. Answ^H^ith 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
Z 01 ___________________________ lnspector_
Name of Candidate fl S AJ H jQaffice Address.
Date of Examination
(Print last name, first name)
k:
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 spoken words over a telephone? *C. Possess necessary vision?
(with corrective devices) (corrective devices acceptable)
Yes P No □ YesM No □ Yesx0^ No □
3: Building
Instructions to Inspector violation (V) items are marked “NO”, issue a Violation Order at the ei Test. Test must
proi
II. Records;________________
v. A, Fire drill records current? V. B. Firemc irvice Elevator Test Records cun r. C. Keys kept at Fire Command Station?
Yes □ No □ Yes □ No N/A □ Yes □ No □
No □ N/A N/A □
□ 3
V. D. Fire Safety Plan and building floor V. E. A current list oh: irdens and phone v, F. Master window keys available?
plan at Fire Command Station?
Yes □ No □
numbers at Fire,
Yes □ Yes □ No □ N/A □ 3
V. G. Building current in actual Fire Drills? (5if-t5ver 3 months) Yes □ No T
Instructions to Inspector—If any violation (V) items are marked “NO”, issue a Violation Order at the end of the Test. Test must
TOTAL (7)
T
Proceed.
III. a. Specific Building Inspection;
Special Instructions—Choose one floor for the general floor inspection
FLOOR
Building Inspection—Signs and Charts—
V. A. Are stairways properly lettered? V. B. Are fliyrs properly numbered? V. C. Is floor diagramposted?
Yes 0 No □
V. D. Are/stairways re-entry
Yes 0 No □
V. E. Are elevators properly lettered on each
Yes 10 No □
V. F. Is floor diagram properly oriented?
3
signs posted?
Yes 0 No □ N/A □
elevat^ bank?
Yes 7 No I □ N/A □ Yey^ No □ 3
V. G. Is elevator sign "In Case of Fire, v. H. Are exit doors unlocked, closed and vf I. Fire Drill Organization Charts
Use Stairs” posted?
YesP No □ N/aC
unobstructed?
Yes^ No □
post^and current?
Ye^Zj No □
3
III. b. Building Inspection—Signs and Charts—Choose one floor for the general floor inspection
FLOOR
TOTAL (9)
4
V. A. Are stairways properly lettered?
Yes 0 No □
V. D. Are/stairways re-entry
V. B. Are
Yes
properly numbered?
No □
V. E. Are elevatorsimproperly lettered on each
V. C. Is flow diagram posted?
Yes/Q No □
V. F. Is floor diagram properly oriented?
3
signs posted? elevatoi ink'
Yes^zT No □
Yes 0 No □ N/A □ Yes 0 No □ N/A □
V. G. Is elevator sign "In Case of Fire, V. H. Are exit doors unlocked, closed and v.*” I. Fire Drill Organization Charts
Use Stairs” posted? unobstructed? posted and current?
Yes 0 No □ N/A □ Yes 0 No □ YesJZ" No □
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.
TOTAL (9)
3
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; \
NAME OF FLOOR WARDEN CONTACTED FLOOR CHOSEN
egg ' TELEPHONE NUMBER
Does Floor Warden have knowledge of;
A. PositiyUuring fire drill or emergency? B. Notification procedures? C. Location of alarm boxes?
Yes'O No □ Yes 0^ No □ Yes &^No □ N/A □
D. Evacuation location?
Yes No □
H. Reportwhether smoke or Fire?
Yes 01 No D
E. Evacuation procedures?
Yes TJ No □
F. Number of exits on floor?
No □
I. Dutiegi^ofbepuW Fire Warden and Searchers?
YesC No □
G. ExamjBiRg for exits on floor?
Ye/P No □_______
V. J. Werefije drills conducted?
Yes Ej No Q
a3
*K. Floor wardens in numerous floors properly trained? YeszS^ No □
Section B; (II, III, IV)_______________ 8 or more atywered “NO" in Section B tails.
Number of correct answers in this section is . Number of incorrect answers is
___________ TOTAL (11)
SECTION B TOTAL (36)
5
Number of N/A answers is Z
NYC-WTC_000168763
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