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Survey date:
Fire-Life Safety Survey Report
Inspector:
Building coordinator:
Responsible parties (RP's) and departments:
YES are acceptable conditions, NO are unacceptable conditions, NA are items that do not apply or were able to be verified during the visit. Comments may be
written at the end of the survey. Fill in OCC NO item's Date Corrected and return to inspector by the date mailed plus 30 days, unless otherwise indicated.
FS = Referred to Facilities Services OCC = Referred to Occupant
Yes
Comments
Item
#
No
N/A
Dt Corrected
(sample)
Referred To
(OCC or FS)
Administration
The EEOP is current and up to date.
1
A scheduled regular fire drill has been completed within the
required timeframe.
2
All evacuation maps and signs are current and conspicuouslly
posted.
3
All hot work is adequately controlled.
4
The building has visible address numbers on the outside of the
building.
5
Housekeeping
Storage of combustible materials is kept neat and orderly.
6
Boiler rooms, mechanical rooms, and electrical rooms are free
of combustible storage.
7
Combustible materials are kept at least three feet away from
baseboard heaters, space heaters, and other sources of ignition.
8
Oily rags are in proper containers that are emptied regularly.
9
Dust and lint collection systems are functional, maintained, and
services as applicable and adequate to prevent build-up.
10
Fire department access roads, hydrants, and fire department
connections are visible and unobstructed.
11
Storage-Seismic Safety
There are at least 18 inches of clearance between storage and
fire sprinklers.
12
Tall bookcases, refrigerators, freezers, and tall cabinets in the
exit path are secured.
13
All shelves holding chemicals or other hazardous items have lips
or other means to prevent items from falling.
14
Electrical
All electrical cords are in good condition and there is no use of
extension cords as permanent wiring.
15
Extension cords and power strips are not daisy-chained to each
other.
16
There are at leat 3 feet of clearance in front of all electrical
panels.
17
There are no open junction boxes or exposed electrical wiring.
18
All electrical panels have a panel cover/door placed on them
19
Entrances, Emergency Exits, Stairs, Hallways, Corr
Corridors and exits are kept free of obstructions and hazardous
materials/processes in accordance with UW Corridor Policy.
20
Exit pathway and emergency lights are maintained.
21
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