Life Safety Self-Inspection Form

Chapter:

House Manager/Inspector Name:

Date of Inspection:

------------------------------------------------------
Directions:
- Please complete the form in its entirety making sure to note any deficiencies in the Final Report section.
- Self inspection forms must be completed and submitted each Thursday by noon. Failure to submit this form on time will result in a loss of social event registration privileges for the following weekend and other possible sanctions.
- Gettysburg College will re-inspect each house on a monthly basis unless there is a condition which presents the possibility of imminent harm.
- Safety & Security will follow up on any outstanding safety issues during the Pre-Party Inspection.
------------------------------------------------------

General House Conditions

1. Have any holes in walls or ceilings been safely patched and/or fixed?
Yes No

2. Are hallways cleared to allow a minimum 3 feet of clearance at all times?
Yes No

3. Is the area around the house, especially around back and/or side doors, generally clear of debris and obstructions?
Yes No

4. Are all grills cleared to within 10 feet of structures when in use?
Yes No

5. Has the chimney been swept and inspected within the last 2 years?
Yes No

6. Is the laundry area kept clean and the dryer vents clear?
Yes No

7. How often is the trash removed from the building?

Exits, Emergency Signage/Lighting, Egress

8. Are all exit routes clear of obstructions?
Yes No

9. Are all fire escapes cleared of objects and in good working order (including snow and/or ice on walkways and stairs)?
Yes No

10. Are all self closing exit doors closed at all times and in proper working order?
Yes No

11. Is there an exit plan posted in the hallways on each floor?
Yes No

12. Are fire escapes and stairwell landings free of all obstructions?
Yes No

13. Are exit signs working with no burned out light bulbs?
Yes No

14. Is emergency lighting placed in stairwells working?
Yes No

15. Is emergency generator in proper working order (FIGI and SIGMA NU only)?
Yes No

Storage

16. Are storage areas free of any flammable liuids (gasoline, paint, thinner, etc.)?
Yes No

17. Are flammable liuids (paint, thinner, etc.) stored in an approved metal storage container?
Yes No

18. Are areas under stairways free of stored materials?
Yes No

19. Is the boiler room clear of all combustible materials?
Yes No

Fire Safety Systems

20. When was the last time the smoke detectors were tested? Provide date. (Chapter should also have on file a copy of the inspection form completed once per year.)

21. When was the last time the kitchen suppression system was inspected (see tag on system)? Provide date. (Chapter should also have on file a copy of the inspection form completed once per year.)

22. Are the fire extinguishers in place and full?
Yes No

23. Provide date of last inspection.

24. Have fire extinguishers had their yearly service?
Yes No

25. Provide date of servicing.

26. Is the fire alarm system operating, with no warning sounds or lights indicating problems with the system?
Yes No

27. Does the chapter house have a working sprinkler system? 28. If yes, provide the date of the last inspection
Yes No

28. If yes, provide the date of the last inspection

29. Do all sprinkler heads have an 18" clearance from other objects mounted on the ceiling?
Yes No

Electrical

30. Are all electrical cords in good condition (no fraying or splices)?
Yes No

31. Are all extension cords and surge protectors properly used (attaching an extension cord to a surge protector is not acceptable)?
Yes No

32. Do all wall outlets and light switches have an unbroken cover faceplate?
Yes No

33. Are all wall outlets and light switches operational?
Yes No

Final Report

34. List problems found on the self inspection.

35. List what actions you took to correct the problems identified during the self inspection.