Self Inspection Form - Manteno Community Fire Protection District - Manteno, Illinois

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Manteno Community Fire Protection District
Name:________________________________________________
Address:________________________________________________
Home Phone #:___________________________________________
Work Phone:_____________________________________________
Email:___________________________________________________
Property Owner:__________________________________________
Property Owner Address:___________________________________
_________________________________________________________
Emergency Contact:________________________________________
Phone:___________________________________________________
Self Inspection Form
IFC/NFPA
Y/N/NA
EXPLAIN
Exits
1008.1.8.3
Exit Door Hardware Properly Operate & in good condition
1011.1&5.1 Exit Signs Operable & Letters at least 6” high on a contrasting background
1028.2
Public Exit Doors unlocked during business hours
315.2.2
Exits, exit enclosures & beneath unprotected interior stairways are free from
1028.3
obstructions, combustible materials or flammable liquids
315.2.2
Aisles clear & provide proper width , with no obstructions that could
1028.3
minimize egress
1014
1006.1
Emergency Lighting operable & appropriately located in exits, aisles,
1003.2.11
corridors & stairways
Fire Extinguishers
906.9
Fire Extinguishers located properly & in good condition
(max. mounting height – 5’ & every 75’ of travel)
NFPA 10
906.2
Fire Extinguisher yearly inspection (tag) current
NFPA 10
906.3
Fire Extinguishers are suitable for the hazard(s)
CONFIDENTIAL
1 of 5
6/1/2015
Manteno Community Fire Protection District
Name:________________________________________________
Address:________________________________________________
Home Phone #:___________________________________________
Work Phone:_____________________________________________
Email:___________________________________________________
Property Owner:__________________________________________
Property Owner Address:___________________________________
_________________________________________________________
Emergency Contact:________________________________________
Phone:___________________________________________________
Self Inspection Form
IFC/NFPA
Y/N/NA
EXPLAIN
Exits
1008.1.8.3
Exit Door Hardware Properly Operate & in good condition
1011.1&5.1 Exit Signs Operable & Letters at least 6” high on a contrasting background
1028.2
Public Exit Doors unlocked during business hours
315.2.2
Exits, exit enclosures & beneath unprotected interior stairways are free from
1028.3
obstructions, combustible materials or flammable liquids
315.2.2
Aisles clear & provide proper width , with no obstructions that could
1028.3
minimize egress
1014
1006.1
Emergency Lighting operable & appropriately located in exits, aisles,
1003.2.11
corridors & stairways
Fire Extinguishers
906.9
Fire Extinguishers located properly & in good condition
(max. mounting height – 5’ & every 75’ of travel)
NFPA 10
906.2
Fire Extinguisher yearly inspection (tag) current
NFPA 10
906.3
Fire Extinguishers are suitable for the hazard(s)
CONFIDENTIAL
1 of 5
6/1/2015
IFC/NFPA
Y/N/NA
EXPLAIN
Fire Doors
703
Fire Doors/closing devices operating properly
703.2
Improper holding (open) devices used or obstructions
107.1,
Any unapproved or inappropriate sealing or openings in fire resistance rated
703.1
construction
NFPA80
Fire Protection Systems
107.1,
Fire Hydrants clear and in good condition
508.5.4,
508.5.5
502
Fire lanes clearly accessible, no obstructions
107.1
Access to standpipes, sprinkler valves, fire department connections and
508.5.4,
other fire protection equipment
508.5.5
107.1
Fire Protection equipment in good working order-protective covers on fire
508.5.4
department connections
508.5.5
912.3.1
907.2.6.3.3
102.8
Smoke detectors are in good operating condition
107.1
NFPA 72
913
Fire Pump Annual Inspection
NFPA 20 &
25
Chapter 9
Annual Sprinkler Certification
NFPA 13
Spare heads and wrench in cabinet
Ordinance
Annual backflow test provided
912.5
907.4.1
Pull Stations accessible, placed appropriately
901.4
Alarm Panel must be accurately labeled
901.7
Alarm system in good working order
Other
506
Knox Box present & in good condition and keys current & functional
1004.3
Occupancy Load sign posted
********
Emergency contact sheet provided
********
Preplan forms/file available/completed
Address present & visible from roadway (at least 4” in height)
505.1
Ordinance
603.9
Gas Meter and piping protected from damage
2703.4
MDSD Sheets on file
CONFIDENTIAL
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6/1/2015
IFC/NFPA
Y/N/NA
EXPLAIN
Storage
Height of stored items at least 18” below sprinkler heads
315.2.1
Stored items at least 24” below ceiling
315.2.1
315.2.3
Combustibles not stored near heat
304.3.1
Materials susceptible to spontaneous ignition, such as oily rags, shall be
stored in a listed disposal container
3404.3.4.4
Flammable safe storage cabinet present, needed? (yes/no)
3404.3.4.4
Storage of the less than 10 gal. shall be in approved containers
3404.3.4.4
Storage in excess of 10 gal. shall be in a approved liquid storage cabinet
3003.5.3
Compressed gas cylinders chained & upright, protective caps in place
310
No smoking signs/hazard signs posted & enforced where appropriate
304.3.3
Dumpsters (larger than 1.5 cu. yds.) shall not be placed within 5 feet of
combustible walls, openings or roof eave lines
104
Unsafe of dangerous conditions present?
Any storage of lawn mowers, snow blowers, etc… in the building
34
34
Are there any NFPA 704 placards on the building
315.2
Storage of combustibles shall be neat and orderly
310
Proper receptacles provided for smoking material
Electrical
605.5
Unsafe use of extension cords
605.6
Damaged, open splices, or modified electrical wiring present-all wiring
605.1
needs to be covered to prevent accidental shock.
605.6
Approved covers on all electrical boxes & switches
Clear access to panel – at least 36 “
605.3
605.3.1
Electrical panel properly labeled
605.4
Use of non-approved multi-plug adapters
NEC
Properly rated fuses in panel
605.3.1
Electrical & Mechanical Rooms need to be identified
Notes/Comments
904.11.6.3
Hood & Duct System clean
NFPA 96
NFPA 96
Fusible links replaced semi-annually
904.11
Current Inspection Tag
NFPA 96
901.6.2
Kitchen suppression system inspected & tested (every 6 mos.)
904.11.6.4
CONFIDENTIAL
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6/1/2015
IFC/NFPA
Y/N/NA
EXPLAIN
Heating & Cooling System
UMC
Mechanical Systems properly maintained
603.5.1
Inspect storage around units/systems- 3 ft. clearance
315.2.3
Storage of combustibles in the mechanical room, boiler room & electrical
room. Must discontinue if storage of combustibles present!
Notes/Comments
CONFIDENTIAL
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6/1/2015
This fire prevention survey was made for the purposes of promoting fire safety and to assist the
owner/manager in correcting conditions, which may contribute to a fire. The list is intended to cover the
most common items/hazards we encounter when performing fire inspections in low hazard occupancies.
It may contain a list of items that must be corrected to bring the safety conditions up to the minimum
standards prescribed by the International Fire Code and Village/County Ordinances. This inspection does
not alleviate the owner/manager’s ongoing obligation to locate and correct safety hazards.
If you have any questions, please call 815.468.7100 between 7am and 4 pm Monday through Friday.
Inspected by:______________________________ _____________________________________
Signature
Print
Date of Inspection:__________________________
I request a follow up call concerning my self-inspection.
I request more information on the Knox Box Rapid Entry Program.
I request information pertaining to the extinguisher training program.
Contact information:_______________________________________________________________
_______________________________________________________________________________
CONFIDENTIAL
5 of 5
6/1/2015

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