"Real Property/Facility Agency Inspection Sheet" - Tennessee

Real Property/Facility Agency Inspection Sheet is a legal document that was released by the Tennessee Department of Transportation - a government authority operating within Tennessee.

Form Details:

  • Released on November 1, 2017;
  • The latest edition currently provided by the Tennessee Department of Transportation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Tennessee Department of Transportation.

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Download "Real Property/Facility Agency Inspection Sheet" - Tennessee

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Real Property/Facility Agency Inspection Sheet
Agency Name: ________________________________________________________________
Period of Inspection:
_
Real Property Section:
Address/Location of Real Property (Shelters/Lots): ________________________________________
Documents requested to be submitted for review:
1) Agency Inspection Sheets for the Real Property for the specified period
2) Receipts for repairs or maintenance work performed on the Real Property
General Information about the Real Property:
a) Is the Real Property discussed in the Maintenance Plan:
Yes
No
N/A
b) Is pavement/concrete in good condition:
Yes
No
N/A
c) Is Handicapped Signage Posted:
Yes
No
N/A
d) No-Smoking signs posted:
Yes
No
N/A
e) Any damage to exterior structure:
Yes
No
N/A
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
Inspected by
: ______________________________
Date: ___________________
(Agency Staff)
This inspection is for contract compliance only.
Revised Jan 2017
Date Reviewed by Multimodal: _______________________
Staff Name ____________________________
Facility Section:
Address/Location of Facility: ________________________________________________________
Documents requested to be submitted for review:
1) Agency Inspection Sheets for the Facility for the specified period.
2) Receipts for repairs or maintenance work performed on the Facility
a. Heating/Air Condition Unit(s) serviced receipts
b. Fire Sprinkler inspection document
c. Smoke/heat detectors inspection document
d. Safety Training sheets for Employees
Real Property/Facility Agency Inspection Sheet
Agency Name: ________________________________________________________________
Period of Inspection:
_
Real Property Section:
Address/Location of Real Property (Shelters/Lots): ________________________________________
Documents requested to be submitted for review:
1) Agency Inspection Sheets for the Real Property for the specified period
2) Receipts for repairs or maintenance work performed on the Real Property
General Information about the Real Property:
a) Is the Real Property discussed in the Maintenance Plan:
Yes
No
N/A
b) Is pavement/concrete in good condition:
Yes
No
N/A
c) Is Handicapped Signage Posted:
Yes
No
N/A
d) No-Smoking signs posted:
Yes
No
N/A
e) Any damage to exterior structure:
Yes
No
N/A
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
Inspected by
: ______________________________
Date: ___________________
(Agency Staff)
This inspection is for contract compliance only.
Revised Jan 2017
Date Reviewed by Multimodal: _______________________
Staff Name ____________________________
Facility Section:
Address/Location of Facility: ________________________________________________________
Documents requested to be submitted for review:
1) Agency Inspection Sheets for the Facility for the specified period.
2) Receipts for repairs or maintenance work performed on the Facility
a. Heating/Air Condition Unit(s) serviced receipts
b. Fire Sprinkler inspection document
c. Smoke/heat detectors inspection document
d. Safety Training sheets for Employees
General Information about the Facility:
1) Facility Exterior:
a) Exterior of Building maintained (no cracks/damage)
Yes
No
N/A
b) Windows have no broken panes or cracks
Yes
No
N/A
c) Paved surfaces are in good condition
Yes
No
N/A
d) Stairs, landings, handrails in good condition
Yes
No
N/A
e) Handrails are fastened securely
Yes
No
N/A
f) Handicapped Access with Signage posted
Yes
No
N/A
2) Facility Interior:
a) Emergency Exits clearly identified and marked
Yes
No
N/A
b) Emergency Lights present
Yes
No
N/A
c) Exit lights Illuminated
Yes
No
N/A
d) Unapproved doors clearly marked “Not an Exit”
Yes
No
N/A
e) Stairs free from material storage
Yes
No
N/A
f) Adequate Ventilation
Yes
No
N/A
g) Handicapped Access with Signage posted
Yes
No
N/A
3) Emergency and Electrical Hazards:
a) Emergency contact information posted
Yes
No
N/A
b) First aid supplies adequate and available
Yes
No
N/A
c) Electrical panels clearly marked and secured
Yes
No
N/A
4) Interior Hazards:
a) Floors are clean and dry
Yes
No
N/A
b) Stairways have handrails
Yes
No
N/A
c) Anti-slip mats and flooring used where appropriate
Yes
No
N/A
d) Hazardous material stored properly
Yes
No
N/A
e) Hazard Communication Training Program in place
Yes
No
N/A
f) Materials Safety Data Sheet accessible
Yes
No
N/A
5) Fire and Weather Safety:
a) Fire extinguishers mounted properly and accessible
Yes
No
N/A
b) Fire extinguishers have been annually inspected
Yes
No
N/A
c) Safety containers are used for flammable liquids
Yes
No
N/A
d) “No Smoking” areas designed
Yes
No
N/A
e) Fire Evacuation Plan Available
Yes
No
N/A
f) Tornado Evacuation Plan Available
Yes
No
N/A
6) Mechanical/Machinery/Tools:
a) Hoist chains and cables inspected regularly
Yes
No
N/A
b) Hazardous areas painted bright colors
Yes
No
N/A
c) Power tools properly grounded
Yes
No
N/A
This inspection is for contract compliance only
Inspected by
: ________________________________________________
(Agency Staff)
Date Inspection Completed: __________________________________________
Additional Comments by Agency:
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Date Reviewed by Multimodal: _______________________
Staff Name ____________________________
Revised November 2017
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