Self-Inspection Report Form

Self-Inspection Checklist

At least once each term, walk through your house and ensure that you can check off all of the following items. There is a space below the list of questions for your comments, questions, or concerns. If your comments/questions/concerns relate to one or more specific item, please note the item number(s).

Date Performed
Name of person completing the checklist
1) Fire Alarm System: Are all indicator lights on the fire alarm panel in the "normal" mode, with no amber trouble lights lit? (If not, call the fire alarm company immediately) Has the system been tested and tagged in the last 12 months? Is the alarm panel locked, and has the key been secured? *
2) Smoke Detectors: Are all smoke detectors in place and working? Are battery-powered smoke detectors tested on a monthly bases, and have you documented the tests? Ensure devices are not covered or tampered with for any reason. *
3) Fire Extinguishers: Are extinguishers mounted on the wall, and are the plastic seels around the pins intact? Do gauges show "full"? Is there a tag attached that indicates it has been inspected within the last 12 months by a fire extinguisher company? Are extinguishers clearly visible? Ensure that fire extinguishers are not tampered with or removed for any reason. *
4) Emergency Plan & Fire Drills: Have all residents been instructed on proper evacuation procedures in accordance with your house emergency plan, and have you provided each resident with a copy of your plan? Have fire drills been conducted in accordance with requirements of the Greek Life Office (at least two per term)? Have you transmitted fire drill reports to Greek Life? Is there an evacuation map and plan posted in every sleeping porch or approved sleeping room? *
5) Fire Doors: Fire doors prevent smoke and fire from traveling through exitways and stairwells. Do all fire doors self-close and latch securely without sticking open? Are doors and jambs free of damage? Doors cannot be blocked open. *
6) Corridors and Exit Doors: Are exit doors easily openable and free of thumb-turn locks and dead-bolts? Are corridors unobstructed AT ALL TIMES (no bikes, desks, trash, etc.)? *
7) Exit Signs & Emergency Lights: Are all bulbs (typically 2) in "EXIT" lights working? Are they continuously illuminated, and do they function in the battery mode? Do emergency lights come on in the test mode? *
8) Wall and Ceiling Decorations: Are all large, combustible wall or ceiling hangings non-comubstible; or have they been treated with flame retardant? *
9) Electrical Fixtures and Wiring: Are all outlet cover plates intact? Have all broken electrical fixtures, appliances, and cords been replaced? HAVE ALL EXTENSION CORDS THAT ARE NOT FUSE PROTECTED BEEN REMOVED? Have ALL wiring repairs been performed by a licensed electrical contractor? Is all electrical wiring free of physical damage and not positioned to run through walls or doorways? *
10) Approved Sleeping Areas: Is sleeping occurring ONLY in approved sleeping areas (i.e., sleeping porches, RA apartment, approved guest room)? OVERNIGHT SLEEPING IS PROHIBITED IN ALL OTHER ROOMS (i.e., study rooms, lounges, TV rooms, etc.). SIGNIFICANT CIVIL PENALTIES WILL BE ISSUED FOR THIS VIOLATION. *
11) Hidden Areas or Illegal Rooms: Is your house free from any illegal rooms created in building voids, attics, or similar spaces? SIGNIFICANT CIVIL PENALTIES WILL BE ISSUED FOR THIS VIOLATION. *
12) Electric Blankets: Are all electric blankets turned off in the mornings? Are electric cords routed in a protected manner and not strung through the metal springs where they could be damaged? Have blankets more than 10 years old been discarded? *
13) Candles: Have all candles been removed from individual rooms if not allowed? Where you allow candles in rooms, is the flame enclosed by the candle holder? Is it placed on a non-combustible and sturdy surface? Are combustible materials located away from the candle? Is the candle never left unattended? *
14) Flammable Liquids: Are all flammable liquids, such as gasoline, solvents, and propane, stored outside of the house in a secured space? *
15) Boiler Rooms: Is your boiler room clear of all combustible materials? Do the doors leading to the room self-close and latch securely? *
16) Kitchen Hood and Duct Systems: Is your kitched hood and ducting system free of grease accumulation? Have grease filters been cleaned frequently to prevent grease build-up (inspect daily - clean if dirty)? Has the hood extinguishing system been serviced and tagged within the last six months? *
17) Walls and Ceilings: Have all holes in the walls and ceilings been patched with equivalent material? *
18) Portable Space and Baseboard Heaters: Is the use of portable space heaters regulated? Are they unplugged when an occupant leaves the room? Does resident keep a 36" clear space in front of the heater and 18" around the sides? Do baseboard heaters have at least 3" of clear space in front? *
19) Laundry Room: Are all dryer vents secure? Is all lint removed from the inside, behind, and around the dryer? *
20) Fire Escapes: Are fire escapes properly marked, unobstructed, and in good working order? Do the windows or doors open onto the fire escape easily? *
I attest that I have conducted a self-inspection to the best of my ability of all of the items identified above and have initiated steps to make any corrections necessary. *
  • Printer-friendly version