Fire Safety Inspection

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DEPARTMENT OF CHILDREN AND FAMILIES
Division of Safety and Permanence
Fire Safety Inspection – Residential Care Centers
Use of form: Use of this form is voluntary; however, completion of this form by the inspector will meet the requirements of DCF 52.55(3).
Residential care centers for children and youth are required to have a fire safety inspection prior to licensure and annually thereafter. A copy
of the initial inspection report shall be submitted to the department with the initial license application, and a copy of the subsequent annual
inspection reports shall be kept on file at the center for 5 years.
Instructions: The fire inspector completing this form must meet at least one of the following three criteria: be appointed by the municipalities
Fire Chief, have Fire Inspector I Certification, or have NFPA Certification. The inspector shall visually observe the physical plant to determine
compliance with each item, note whether the center is in compliance by checking either “Yes” or “No” and indicate any comments on the last
page in the Comments Section. The fire inspector is encouraged to call or write the licensing specialist if they have any questions or observe
any condition which requires immediate attention. If any items are indicated as not being in compliance at the time of the initial inspection, the
required modifications must be made and a final inspection completed to document compliance.
Note: Department of Commerce has been retitled to Department of Safety and Professional Services. All “Comm” codes became “SPS”
codes effective January 2012.
Name – Facility
Name – Licensee
Facility ID Number
Address – Facility (Street, City, State, Zip Code)
County
FIRE SAFETY
Yes
No
1.
Is a detailed flow-chart type evacuation plan that clearly indicates the direction of each exit for emergency
evacuation posted in a conspicuous place in each building? [52.55(1)(a)]
2.
Does the evacuation plan provide for safe conveyance of all residents promptly from the center by staff in
one trip? [52.55(1)(b)1.]
3.
Does the evacuation plan designate places away from the center to which all residents are evacuated or at
which all are to meet so that it can be determined if all residents are out of danger? [52.55(1)(b)2.]
4.
Does the center comply with chs. SPS 361 to 365, the Wisconsin Commercial Building Code and
applicable local ordinances for number and location of exits, type of exits, exit passageways, and
illumination of exits and exit signs? [52.56(5)(a)]
5.
Are halls, stairs, the attic, closets, basement, furnace room, laundry room, yard and garage free of rubbish
or waste accumulation? [52.51(1)(e)]
6.
Are all bedrooms for residents who are not able to walk, or who can walk only with a means of support
such as crutches, located on a floor level that has an exit discharging at grade level? [52.54(10)]
7.
Are all habitable rooms with floors below grade level in compliance with chs. SPS 361 to 365, the
Wisconsin Commercial Building Code and applicable local ordinances? [52.56(7)]
8.
Do all interior doors (except for locked rooms or units under s. DCF 52.42), including those for closets,
have fastenings or hardware that will allow opening from the inside with one hand without the use of a key?
[52.51(3)(a)]
9.
Are all doors equipped with a lock or latch designed to permit opening the door from either side in case of
emergency? [52.51(3)(b)]
10.
Does an employee on each work shift have a key or other means of opening doors with locks or closing
devices in each building housing residents? [52.51(3)(c)]
11.
Is the smoke detection system installed according to the manufacturer’s instructions and in accordance
with ch. SPS 316 and chs. SPS 361 to 365, the Wisconsin Commercial Building Code and applicable local
ordinances? [52.55(4)(a)]
DCF-F-CFS0357 (R. 02/2016)

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