(OPTIONAL) TO PRINT THIS AS A BLANK FORM:
Right click in the white space, select print, and it should print just the questions and empty checkboxes.

Do not hit the SUBMIT AND PRINT button until you've completed the form electronically below.

Name of Department

*

Admin/Finance/HR/Comm Codes/Planning Fire Station 1 Fire Station 2 Fire Station 3 Fire HQ trailer IT/EOM Library Parks & Rec Main Office Police Public Works Main Building Public Works Workshop Public Works Trailer 1 Public Works Utilities Trailer 2 Public Works Storage Barn Waste Water Water Treatment Parks & Rec Evans Park Parks & Rec Fischer Park Parks & Rec Skate Park Parks & Rec Senior Center/Winchester Parks & Rec Workshop

Name of Employee Completing Walk-Through

*

Date Walk-through completed

*

AED tested

*

YES N/A

NO

AED Pad & Battery Expiration Date (If no AED, write N/A)*

Fire extinguishers checked

*

YES N/A

NO

Are Safety Data Sheets (SDS/MSDS) updated and kept in a place where all staff can access?*

YES N/A

NO

EXTERIOR BUILDING CONDITIONS

Are walking surfaces clean, clear of debris, and dry? *

YES N/A

NO

Are trees and tree roots too close to foundation?

YES N/A

NO

Are tree limbs and vegetation trimmed away from the building?*

YES N/A

NO

Are stairs, steps, handrails, and landings in good condition?*

YES N/A

NO

Is the roof in good condition?
Are metal roofs and sheet metal siding securely fastened to prevent damage in high winds?*

YES N/A

no

Are gutters and downspouts clear and in good repair?*

YES N/A

NO

Are parking and security lights present and in functional condition?*

YES N/A

NO

Are security cameras present and in functional condition?*

YES N/A

NO

Are fencing and gates in good working condition (with nearby trees and limbs cut back)?*

YES N/A

NO

Are trash and combustibles kept away from the building?*

YES N/A

NO

Are radio towers properly grounded?*

YES N/A

NO

INTERIOR BUILDING CONDITIONS

Is general housekeeping acceptable and storage neat and orderly?*

YES N/A

NO

Are there any cracks noted to the foundation and walls?*

YES N/A

NO

Is furniture in a good state of repair?*

YES N/A

NO

BUILDING EVACUATION AND SAFETY

Are exits properly identified and lighted?*

YES N/A

NO

Are exit paths clear?*

YES N/A

NO

Are exit doors operable and equipped with panic hardware?
*

YES N/A

NO

Is emergency lighting operable?
*

YES N/A

NO

Are evacuation floor plans posted?
*

YES N/A

NO

FIRE PREVENTION

Are emergency phone numbers posted in conspicuous areas throughout the building?
*

YES N/A

NO

Does the fire alarm work?
*

YES N/A

NO

Has the fire alarm been tested?
*

YES N/A

NO

Are portable fire extinguishers available?
*

YES N/A

NO

Are extinguishers serviced/tagged annually?
*

YES N/A

NO

Is the sprinkler system operable and tested annually?
*

YES N/A

NO

When was the sprinkler system last tested? (Dam & PSI)*

Are smoke, heat and other detection alarm systems tested annually?
*

YES N/A

NO

Is there a smoke/heat detector located near the furnace room?
*

YES N/A

NO

Is the No Smoking on city property policy enforced, including in city vehicles?
*

YES N/A

NO

Are fire doors self-closing and tested?
*

YES N/A

NO

Are combustibles and trash controlled?
*

YES N/A

NO

Are flammables properly stored in cabinets?
*

YES N/A

NO

Is there any evidence of electrical equipment overheating?
*

YES N/A

NO

Are chimneys and flues inspected regularly?

YES N/A

NO

Is lightning protection installed on towers, steeples, or spires?*

YES N/A

NO

Are holiday decorations noncombustible and Underwriters Laboratories listed (UL-listed)?
*

YES N/A

NO

Is there any evidence of electrical wiring overheating, blown fuses, tripped circuit breakers or worn insulation?
*

YES N/A

NO

Are power strips or extension cords plugged into other power strips or extension cords (daisy chained)?*

YES N/A

NO

Are portable heating devices UL-listed?
*

YES N/A

NO

KITCHEN FIRE PREVENTION

Is the cooking ventilation system equipped with grease filters or extractors?
*

YES N/A

NO

Are cooking filters clean with no grease build-up?
*

YES N/A

NO

Does a dry chemical fire suppression system protect ductwork, cooking surfaces, and each deep fat fryer?*

YES N/A

NO

Are dry chemical fire suppression systems serviced semi-annually by a licensed contractor and tagged accordingly?

YES N/A

NO

Is the dry chemical fire suppression system linked to a shut-off valve to the fuel supply?
*

YES N/A

NO

Are deep fat fryers equipped with thermostats and high limit temperature control (475º F)?
*

YES N/A

NO

Is there a 10-pound dry chemical fire extinguisher (bicarbonate-based) in the immediate cooking area?
*

YES N/A

NO

Is there a decent cook or baker on premises? :)

BOILERS & HEATING EQUIPMENT

Are boilers and water heaters serviced regularly?
*

YES N/A

NO

Are state inspection certificates on file and current?

YES N/A

NO

Is any water/steam/fuel leakage noted?
*

YES N/A

NO

Is there a preventive maintenance service contract in effect on heating/air conditioning equipment? *

YES N/A

NO

ELEVATORS

Are inspection certificates posted?
*

YES N/A

NO

Is there a preventive maintenance/service contract in effect?
*

YES N/A

NO

Are "Do Not Use Elevator in Fire Emergency" signs posted and legible?*

YES N/A

NO

OUTSIDE GROUNDS

Is the parking area well maintained?
*

YES N/A

NO

Are exterior walkways in good physical condition?
*

YES N/A

NO

Is exterior illumination adequate?
*

YES N/A

NO

Are all lights functional?
*

YES N/A

NO

Is signage adequate and properly secured?
*

YES N/A

NO

Are walkways, roads, and parking lots kept clear of ice and snow?
*

YES N/A

NO

COMMENTS