Life Safety and Construction Binder

Emergency Preparedness Plan and Training Records 
(Located in separate binder in the Safety Training Director Office.)

Fire Plan

Evacuation
Evacuation Plan in Case of Fire 
Evacuated Zone where fire is to another Zone

1.    Evacuation of an area is necessary in the presence of visible smoke/flame
2.    Person in Charge gives order for evacuation of building if needed.
3.    Residents are moved to a safe area as designated by the Person in Charge
4.    Begin by moving residents to opposite side of fire doors, using most efficient means
       available.
5.    When evacuating residents, go to safest zone as determined by person in charge
6.    Personnel from the employee pool at the Nurses Station will be assigned to assist in
       evacuating residents
7.    The Person in Charge shall leave the building only after a thorough inspection of the
       resident area, to ensure that all residents and staff members have been evacuated; also secured the safety of the resident's records
8.    The Person in Charge will ensure that all staff members have been accounted for and/or evacuated, and is responsible for counting residents, according          to midnight census sheet and staff.

Note: If building evacuation is necessary, refer to Disaster Plan

Generator and Transfer Switch Records
A permanent record of the EPSS inspections, tests, exercising, operation, and repairs shall be maintained and readily available.

Any Town Nursing Home
Emergency Generator - Weekly Inspection Checklist
 

Any Town Nursing Home
Emergency Generator – Monthly Test Log

Generator Model:  Caterpillar                           Engine Model:  C18                                                                          Date Installed:  July 21, 2023
Standby kW nameplate rating: 600 kW              30% of standby rating = 180 kW           Fuel type: Diesel             Normal operating temp: 180° to 200° F

Interior Finish Documentation:

• Inspection:
  • Hoods shall be inspected monthly with date noted on log sheet.
  • Semiannually – maintenance and inspection for cleaning shall be conducted.
• Records:
  • Documentation shall be retained for the duration of the product in the facility.
• Product Information Sheet:
  • Floors
• Description
• Product Specifications
• Physical Properties
• Fire Hazard Classification:
  • Fire Rating: ASTM E-84 or ANSI/UL 723
    • Flame Spread: 25
    • Smoke Developed: 20
• Walls
  • Description
  • Product Specifications
  • Physical Properties
  • Fire Hazard Classification:
    • Fire Rating: See Chapter 10, Table 10.2 of NFPA 101 for the appropriate test method which will define the Flame Spread and Smoke Developed standards.

Interior Finish Documentation
Documentation shall be retained for the duration of the product in the facility

Portable Fire Extinguishers Records 
Where monthly manual inspections are conducted, records for manual inspections shall be kept on a tag or label attached to the fire extinguisher, on an inspection checklist. 

Fire extinguishers inspected via electronic monitoring, whereby the extinguisher causes a signal at a control unit when a deficiency occurs, shall provide record keeping in the form of an electronic event log at the control panel. Where electronically monitored systems are employed for inspections, records shall be kept for fire extinguishers found to require corrective action. 

Records shall be kept to demonstrate that at least the last 12 monthly inspections have been performed. 

Monthly Fire Extinguisher Inspections
January 2026

Range Hood System Records

At least monthly, the date the inspection is performed and the initials of the person performing the inspection shall be recorded. Records shall be retained for the period between the semiannual maintenance inspections. 

At least semiannually, maintenance and inspection for cleaning shall be conducted. Records shall be retained for a period of 1 year after the next required maintenance and inspection for cleaning.

Monthly Range Hood Extinguishing System Inspections
 

Range Hood Systems

Ø       Inspection of UL300 Kitchen Range Hood:

• Monthly - Hoods shall be inspected per manufacturer’s listed installation and maintenance manual or the owner’s manual.
• Semiannually – The range hoods automatic extinguishing system must be serviced and inspected for cleaning.

Ø       Records:

• The date of the inspection and the initials of the inspector shall be kept on record.
• Monthly Records shall be retained for the period between the semiannual maintenance inspections.
• Semiannual Records shall be retained for a period of 1 year after the next required maintenance and inspection for cleaning.

Ø       Inspection Sheets: These are usually provided by the company doing the inspection.

• Wet Agent Fire Suppression System Inspection and Testing Report.
  • Work Site #
  • Name of facility
  • Street Address
  • City – State and zip code
  • Authority Contact and phone number
  • Date – Time in and time out
  • Last maintenance date and performed the maintenance
  • Manufacturer
  • Type of Wet Agent
  • Control/Release Data
  • Expellant Gas Line
  • Tank/Cylinder Data
  • Nozzles
  • Detection Data
  • Remote Release Data
  • Gas Valve Data
  • Electrical Functions
  • Notification/Annunciation

Ø       Inspection and Cleaning of Kitchen Exhaust Systems

• The extinguishing system is in its proper location.
• The manual actuators are unobstructed.
• The tamper indicators and seals are intact.
• The maintenance tag or certificate is in place.
• No obvious physical damage or condition exists that might prevent operation.
• The pressure gauge, if provided, shall be inspected physically or electronically to ensure it is in the operable range.
• The nozzle blow-off caps, where provided, are intact and undamaged.
• Neither the protected equipment nor the hazard has not been replaced, modified, or relocated.
• If any deficiencies are found, appropriate corrective action shall be taken immediately. At least monthly, the date the inspection is performed and the initials of the person performing the inspection shall be recorded. The records shall be retained for the period between the semiannual maintenance inspections.
• A K-type fire extinguisher is required in kitchens that are equipped with a UL 300 hood system. A sign must be installed instructing on the use of the extinguisher.