Free Wall Closure Inspection Checklist-F-00016 - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F-00016 (12/08)

STATE OF WISCONSIN

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

Item EXAMPLE: Adjacent Spaces Adjacent Spaces Barriers Pathway Neg Ventilation Protective Equipment Debris Electrical Attachment ­ Small Attachment ­ Large Wall Track Wall Channel Fireproof ­ Missing Utility Abut Wall Construction Won / Vert Doors Penetration ­ Floor Penetration ­ Wall Exits Piping Fire Dampers Smoke Dampers Ductwork

ID A A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA BB CC

Inspection Spot Check Method and Code (NFPA 101, unless otherwise shown) (1) Dust free; (2) Sep contr path; (3) Clean mat; (4) Exit path; (5) Sprkled [§4.6.10.1]

No.

ID + No. C­2

Issue Locations Exit blocked by pipes

Risk Management
(1) Dust free; (2) Sep contr path; (3) Clean mat; (4) Exit path; (5) Sprkled [§4.6.10.1] (1) Rated, if no sprkler/smk detect/fire watch; (2) Dust tight to pt spaces (1) Interior mats; (2) Clear paths [§4.6.10.2]; (3) Exits marked (1) Neg fan if adj to pt areas; (2) Recorded pressure > .02":wg (1) Hard hats, if work overhead; (2) Follow hosp PPE rules (1) Trash ­ excess removed; (2) Dust clean [241 §3-4.1] (1) No open power

Fire Proof
(1) Beam clamps, small attachments [220 §3] (1) Large attachments [220 §3] (1) Top track tight to steel [220 §3] (1) Hat channel tight to steel [220 §3] (1) Missing insulation; (2) Thin insulation [220 §3] (1) Adj piping next to steel; (2) Adj duct next to steel [220 §3]

Wall Construction
(1) Rated wall-framed slip joint; (2) GWB will butt on both sides; (3) No parallel ducts/pipes (1) 2-hr framed supports

Penetration
(1) In-wall cavities per UL design quality [§8.2.3.2.4.2] (1) Qual seals per UL design [§8.2.3.2.4.2] (1) No pass-thru util [§7.1.36.2.1]

Med Gas
(1) Labeled with gas and (2) flow direction [99 §4-3.1.2.14]

Ventiliation
(1) Framed around duct per mfgr install [§3-4.6] (1) Framed around duct per mfgr install [§3-4.6] (1) Sealed ducts

Misc