Survey Planning Process Document Review
Life Safety Specialist Facility Tour Checklist Form
Building Name: ______Date: ______
Description / Location / Test Result / CommentsStairwell / P F
Stairwell / P F
Stairwell / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke door / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
Smoke compartment / P F
1
Facility tour checklist form, continued
Description / Location / Test Result / CommentsFire door / P F
Fire door / P F
Fire door / P F
Fire door / P F
Fire door / P F
Fire door / P F
Fire door / P F
Fire door / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Fire compartment / P F
Corridor door / P F
Corridor door / P F
Mechanical equip. room / P F
Mechanical equip. room / P F
Mechanical equip. room / P F
2
Facility tour checklist form, continued
Description / Location / Test Result / CommentsLinen/ trash chute / P F
Linen/ trash chute / P F
Linen/ trash receiving rm / P F
Fire panel / P F
Fire pump / P F
Loading dock / P F
Medical waste storage / P F
Chemical storage / P F
Compressed gas storage / P F
Compressed gas storage / P F
Emergency generator / P F
Emergency generator / P F
Medical air compressor / P F
Kitchen / P F
PFI verification / P F
PFI verification / P F
PFI verification / P F
ILSM verification / P F
ILSM verification / P F
P F
P F
3