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REGEIVEL <br /> MONTHLY SAFETY INSPECTION FEB 17 2016 <br /> ENVIRON ;ENTAL <br /> Inspection HFAI_THl1Fp <br /> Performed By: Date of inspection: 4 .TMFAIT <br /> Location Name: Location Address: <br /> Directions: use this form once per month to evaluate compliance at your facility. <br /> * Check Either"Yes to indicate compliance,"No"to indicate out of compliance or"N/A"to indicate that the <br /> situation described done not apply to your location. <br /> * If your location does not meet standard as indicated in the statements below,explain all measures being <br /> taken to correct the condition in the"Comments"Section. <br /> * Employees assigned to complete this checklist must complete the form as accurately as possible. <br /> * Completed Monthly Inspections must remain on file at the location for a minimum of three(3)years. <br /> Comments: If you answer"NO"to any <br /> of the items below,immediately report <br /> to your manager and you must explain in <br /> this section what corrective action you <br /> FIRE SAFETY YES No N/A will/havetaken. <br /> Fire Extinguishers are: <br /> * Accessible <br /> * Securely Mounted <br /> * Tagged <br /> * Serviced/Inspected within the previous 12 Months <br /> * Fully Charged <br /> * Seals and tamper pins in place <br /> * Free of damage <br /> Have you initialed and dated each fire extinguisher tag after <br /> completing the inspection? <br /> Fire hoses, hydrants and standpipes around facility are <br /> clear and accessible for fire department use(min 3' <br /> clearance)? <br /> ave you visually observed there is a minimum o <br /> clearance from any sprinkler head? <br /> Have you confirmed there are no accumulation o <br /> combustible items under stairways(pallets,file boxes, <br /> cardboard debris,wood,supplies,etc.)? <br /> Have you tested all emergency lighting by pressing the <br /> button until the lights turn on? <br /> Are evacuation maps current and posted throughout te <br /> facility? <br /> Monthly run time logs tor emergency generators and/or <br /> fire pumps are completed and documented? <br />