Free Final Occupancy Inspection Checklist-F-00015 - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F-00015 (12/08)

STATE OF WISCONSIN Page 1 of 2

FINAL OCCUPANCY INSPECTION CHECKLIST
Name - Facility Project Distribution To Name ­ DHS Inspector Area Inspected Tour With DHS Inspector No. Inspection Date Anticipated Occupancy Date

Item
Fireproofing Penetration ­ Floor Penetration ­ Wall Wall / Ceiling Construction Suite

ID
A B C D E

Inspection Spot Check Method and Code (NFPA 101, unless otherwise shown) Building Construction
(1) Beam clamps; (2) Adjacent pipe/duct; (3) Missing insul [220 §3] (1) Qual seals per UL design [§8.2.3.2.4.2] (1) Qual seals per UL design [§8.2.3.2.4.2] (1) Rated walls constr; (2) Ceiling not light (1) <100' TD w/1 rm; (2) <50" w/2 rms; (3) <5 ksf-sleep; (4) <10 ksf-other; (5) 2 exits >2.5 ksf [§18.2.5.1]

No.

ID+No.

Issue Locations

Exits
Egress Path Exits Exit Signs Corridors F G H I (1) To public way [§7.7.1]; (2) multi lamp/fixt [§7.8.1.4]; (3) no haz [§7.5.1.7]; (4) min 3' [§7.3.4.1] (1) No pass-thru util [§7.1.3.2.1] (1) Path not apparent [§7.10.1.4]; (2) No exit if may be mistaken [§7.10.8.1]; (3) Stair sign [§7.10.1.3] (1) Open rms w/smk det [§18.3.6.1]; (2) Dead end < 20'; (3) InPt = 8'; (4) Other = 4' [§18.2.3.3]

Doors
Fire Barrier Doors Smoke Barrier Door Corridor Doors Dutch (in corr) Auto Operators Delayed Egress Won / Vert Locking / Mag J K L M N O P Q (1) Self-close; (2) Latch; (3) Hold open w/smk det; (4) Rated; (5) 1/8" gap; (6) 30# open [§8.2.3.2] (1) Self-close; (2) Astragal; (3) Hold open w/smk det; (4) Dual egress; (5) 1 ¾" / 20m [§18.3.7.5-8] (1) Latch [18.3.6.3], dbl drs; (2) Astragal; (3) Auto-flush [18.2.3.5], out-swing; (4) > 50%; (5) > 7" [7.2.1.4.4] (1) Self-latch; (2) Sealed gap [§18.3.6.3.6] (1) 50# open; (2) signs; (3) Latch w/smk det / both sides [§7.2.1.9] (1) 15s open; (2) Signed; 3) 1/path; (4) Fully sprkled; (5) FA open; (6) Elec open [18.2.2.2.4; 7.2.1.6.1] (1) Open at > 6"/s < 24"/s (1) For pt safety [§18.2.2.2.4]; (2) Sensor w/button within 5'; (3) FA/Elec open [§7.2.1.6.2]

Sprinkler
Fire Extinguisher Sprinkler Block Spacing Valves R S T U (1) Conspicuous; (2) Accessible; (3) Tagged; (4) < 150' apart [§7.9.4 ­ NFPA 10] (1) Ceiling blockage; (2) Shelf blockage; (3) Wall shadow [13 §6-5]; (4) Open ceiling (1) No spklr; (2) > 6'; (3) < 15' apart; (4) > 4" corners; (5) > 7 ½ ` to wall; (6) 12" to ceiling [13 §5-6.3] (1) Valves supervise; (2) QR in sleep smk comp [§18.3.5]

Fire Alarm
Fire Alarm Op Smoke Detectors Staff Training V W X (1) Doors close; (2) Strobes visible; (3) Audible volume [§18.3.4] (1) > 3' to air grills; (2) @ door holds; (3) 2 @ 24" hdr [72 §2-10.6] (1) Staff know how to respond; (2) Know compartments [§18.7.2]

F-00015 (12/08)

Page 2 of 2

Med Gas
Piping Valve, Isolation Zone Valve and Alarm Y Z AA (1) Labeled with gas and (2) Flow direction [99 §4-3.1.2.14] (1) Labeled; (2) Locked [99 §4-3.1.2.3] (1) Labeled with gas and (2) Space served; (3) Close-caution sign [99 §4-3.1.2.14]

Ventiliation
Air Flow Fire Dampers Smoke Dampers Duct Smoke Detectors BB CC DD EE (1) Hold tissue strip at cross-corr smoke/fire/rm drs to check neutral air flow [90A §2-3-11] (1) At 2 hr walls/shafts [90A §3-3.1]; (2) Mfgr install [§3-4.6]; (3) Access door; (4) Label [§2-3.4] (1) Iso AHU > 15 kcfm on SA and (2) RA [90A §2-3.9.2]; (3) RA into riser [IBC} (1) AHU > 2 kcfm: SA main prior to branch; (2) AHU > 15 kcfm: RA @ shafts and (3) AHU [§4-4.2]

Electrical
Panels Patient Care Bed Areas Light Switching Emergency Lighting FF GG HH II (1) Directory complete [70 §384-13]; (2) > 3' work space [70 §110-26] (1) Min 4 HG recpt on (2) 2 ckts [70 §517-18] (1) Daylight > 250sf; (2) Occup sen; (3) Dual switch [COMM 63.1050] All norm off, check emergency lights (1) > 1fc; (2) Multi lamp/fixture > 2fc [§7.8.1]

Specialty Areas
Kitchen Hoods Anesthetizing Loc Life Support ­ Med Gas Life Support ­ Electrical JJ KK LL MM (1) UL300 sys; (2) FA connect; (3) w/utility shut-down; (4) K exiting [96 §7]; (5) Hood MU air [96 §5-3] (1) Med gas valves; (2) Alarm [99 §4-3.1.2.2&3]; (3) Smoke vent sys seq of op [99 §5-4] (1) Med gas valves; (2) Alarm [99 §4-3.1.2.2&3] (1) Min 6 HG recpt; (2) 1 norm; (3) 1 ded ESS ckt; (4) Labeled w/panel and ckt [70 §517-19]

Documents
Local BI and FD Sprinkler Alarm Generator Tests Outlet Tests Air Balance Med Gas Certification Compliance Statement Form (F-62494)

Misc
NN OO PP QQ RR It is acceptable to use the space, provided (1) the local AHJ gives approval, (2) all issues are corrected, and (3) certification of correction is e-mailed to the state inspector. The construction manager must submit photographic evidence of correction of items marked with a "P." Reinspection is required. Please call to schedule. SIGNATURE - Inspector Date Signed