HomeMy WebLinkAboutColorado River Fire Rescue - Safety Survey FormColorado River Fire Rescue
Main (970) 625-1243
Fax (970) 625-2963
Business Name:
SAFETY SURVEY FORM
Address: = �`
Name of Contact:
Emergency Phone / Contact:
1850 Railroad Avenue
Rifle, Colorado 81650
1907
Phone: Date: -
City: Zip:
Phone:
IFC:
G
D
NA
G
D
NA
Fire Department Access
Housekeeping
1. Fire Lanes / Access
26. Areas free of excessive combustibles
✓
2. Proper Addressing
27. 18" Clearance below sprinklers /
24" Clearance all other ceilings
i
3_ Knox Box (proper kevs /lacement)
v-
Building Services
28. 30" Clearance in front of mechanical
Electrical Equipment
/
4. Electrical
v'
5. Extension cords / multi face adaptors
V
29. Storage room(s) / Utility rooms
accessibility, cleanliness
6. Breaker Panel accessible / labeled
i/
7. Main electrical shutoff accessible
V
Hazardous Areas / Storage
8. Emergency Generator
Last Tested:
v
30. Hazardous liquids / paints / acids -
areas / cabinets labeled
9. Heating Appliance / Portable
31. Hazardous Gases
10. Combustible air source
32. Explosives
11. Water heater obstructed
33. Dust / Fumes
12_ Gas Shutoff accessible
v ,
34. MSDS paperwork available
13. Elevators Inspection Forms
Fire Resistive / Rated Construction
Fire Protection Systems
35. Stairway(s)
14. Fire Alarm System /
Current test and inspection records
36. Corridors
37. Elevator Shaft
15. Special Extinguishing system / type
38. Floor / Ceiling / Walls
16. Hood / Duct system clean
39. Major Structure members
i
17. Sprinkler System /
Current test and inspection records
Occupancy Features
40. Occupant Load Sign
18. Standpipes /
Current test and inspection records
/
41. Fire Drills / Evacuation
I
19. FDC
v
Fire Extinguishers
20. Date Last Inspected:
✓ "
21. Proper type & size
✓
22. Mounted properly
V
Means of Egress
23. Clear & Unobstructed
24. Emergency Lighting
v
25. Stairways in Order
G: Good
D: Deficient
012 1.7-
t~� -C• r^- .7�� • ! 1 •4- •
NA: Not Applicable
Remarks / Recommendations / Requirements
Pre -Plan Updated: 0 Yes 0 No Officer's Review:
(Signature)
Inspected By: _ _ Date:
(Print & Sign)
Received By: _ Date:
(Print & Sign)
Re -Inspection Date: Inspection Completion Date:
Initials Fire Department: Occupant / Owner
Revised 12/20/17 FG Page: