Daycare Inspection Form

Concern and corrective action required:

Address Numbers - visible from road Y____N____

Facilities with over 50 occupants: Exit doors swing outward with panic hardware. Y____N____ NA___
Exit Lights - operational when button depressed. Y____N____
Date of annual service/inspection - Fire Alarm ___/___/____ Fire Sprinklers___/___/____

Knox Box - proper key(s) inside. Y____N____ NA___

Emergency Lights - operational when tested. Y____N____ N/A_____

Upper Floors - being used for childcare. Y____N____ NA____

Comments:____________________________________________________

Basement - being used for childcare. Y____N____NA___ Comments:________________________________________________________

Attached Garage - Y____N____ NA___ Pet doors are not allowed. Comments:_________________________________________________

Windows - sleeping rooms provided with at least one emergency egress. Y____ N____.
Window___ Door____ Furniture or platform under window if over 44". Y____ N____ Comments:__________________________________________________________

Electrical Panel - all breakers labeled; maintained in good condition;
accessible/3 foot clearance. Y____N____

Flammable/Combustible Liquid Storage - gasoline stored in garage. Y____N____Comments:_____________________________

Fire Extinguishers - date of last annual service ___/___/____ Comments:_______________________________________________

Smoke Detectors - In hallway or corridor outside of sleeping room. Y____N____
Operational Y____N____ Batteries changed annually Y____N____

Extension Cords - Y____N____ Comments:______________________________________________________________

Exits - doors and windows operational and not blocked. Y____N____

Portable Heaters - Y____N____ Comments:______________________________________________________________

Kitchen - cooking area free of grease on stovetop and in range hood. Y____N____

Housekeeping - Combustibles; egress pathways. Y____N____

Telephone - "911" sticker. Y____N____

Monthly Checklist - filled out correctly. Y____N____

Does facility have adequate square footage (35 sf. per child) - Y____N____

Outside fenced play area - Y_____N_____ 75 sf. per child - Y_____N_____

Staff Ratio ____ :____ (child:adult)

Current CPR Certification Y____N____

Inspected by: ______________________________________ Date:___________

NOTE: Please call ___________for a re-inspection. Date in compliance:__________________

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DAYCARE MONTHLY SAFETY FORM

EXPLANATIONS

I. FIRE DRILL:

Fire is always unexpected. If the fire drill is always conducted the same way, it loses much of its value. Then in an actual fire when it is not possible to follow the usual routine of the fire exit drill to which occupants have become accustomed, confusion and panic may ensue. Fire drills should be carefully planned, held at varying times, and use a different means of exit. The fire drill should be initiated by sounding of the alarm. The occupants shall then leave the building to a safe distance.

II. EVACUATION TIME:

The recommended time for evacuation is two (2) minutes.

III. FIRE ALARM CHECK:

All alarms shall be sounded once a month to ensure that the alarms are functional and audible in all parts of the building.

IV. SMOKE DETECTOR CHECK:

All smoke detectors shall be tested according to the manufacturers recommendations or by smoke from a punk, cigarette or similar device. No not test with paper or other highly flammable materials. The test button will not suffice. It is only for testing battery or circuit condition. Smoke detectors require occasional cleaning depending upon local conditions. The owner's manual should be consulted for the proper cleaning procedure.

V. EMERGENCY LIGHTING CHECK:

The State Fire Marshal requires, where applicable, emergency lighting be tested by shutting down the main electrical circuit. The National Fire Protection Association (NFPA) suggests that a functional test be conducted every month and that a test of 1 1/2 hour duration be conducted annually (NFPA 1, 1-9.8).

VI. FIRE EXTINGUISHER CHECK:

Inspect for each of the following items:

1. There are no obstructions to the access or visibility of the fire extinguisher.

2. The fire extinguisher is properly mounted in the designated place.

3. The fire extinguisher operating instructions are facing forward.

4. The tamper indicator is not broken or missing.

5. Determine the fullness of the fire extinguisher by weighing or "hefting".

6. The fire extinguisher has no visible physical damage nor is the nozzle clogged.

7. The pressure gauge is in the operable range.

MAINTENANCE OF FIRE EXTINGUISHERS:

Annual maintenance is required to be done by a fire equipment servicing agency. The annual maintenance should consist of a basic examination of the three basic element of an extinguisher:

1. Mechanical parts.

2. Extinguishing agent.

3. Expelling means.

During the annual check, the need for hydrostatic testing of cylinders should also be determined.

VII. HOUSEKEEPING CHECK:

The building shall be free of accumulations of highly combustible materials such as paper, oily rags, and other waste on the interior and accumulations of dry weeds, leaves, etc. on the exterior.

VIII EXITS CHECK:

All exits shall be checked to ensure that they are free of blockage. The doors shall swing free and be openable from the inside without the use of a key or any special knowledge or effort. Any egress window shall be checked to ensure that they are operable.

IX. FUEL AND ELECTRICAL SHUTOFFS:

The employees shall be made aware of how to shutoff the main electrical supply and any fuel used for heating such as oil or gas.

X. Furnace Filter Check:

The furnace filter shall be checked monthly and cleaned as needed.

XI. TELEPHONE 911:

A telephone is required on the premises. The phone number, 911, shall be posted to ensure that the number, 911, is used for fire, police, and medical emergencies.

XII. KITCHEN CHECK:

The kitchen shall be free of combustible waste and the cooking area free of grease on the stove top and in the range hood.

XIII. AVERAGE STAFF RATIO (Childcare Only):

For each month, the month's average child/staff ratio shall be identified and noted on the Monthly Safety Form.

The Monthly Safety Check Sheet shall be submitted to the fire department and placed in a permanent address file.