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4000 Series - Students » 4201 Form - Principal's Monthly Fire Drill and Inspection Report

4201 Form - Principal's Monthly Fire Drill and Inspection Report

INSTRUCTIONS: G. S. 115C-28/8 (S) requires each principal “to conduct a fire drill the first week after the opening of school and thereafter at least one fire drill each school month, in each building in his charge, where children are assembled.” It further requires each principal “to inspect each of the buildings in his charge at least twice each month during the regular school session” and to file a written report on this form once each month with the school officials indicated. Failure to perform these duties is considered a misdemeanor (G. S. 115C- 525(c).
Administrative Unit:
A. Last fire drill held on:
(month)                    (day)                       at o’clock 
Time consumed in evacuation of building:
min.             sec.
If time varies measurably from previous evacuation, explain
B. Inspection for the purpose of keeping all buildings on this school site safe from accumulation of trash and other fire hazards has been made twice this month, in accordance with law, as follows:
(The two inspections shall be made no less than 10 days apart.)
    Inspection this month 
  Insert day of month First Second
    Yes No Yes No
1. All corridors, halls, and tower stairways are clear of obstructions          
2. All doors used for exits are plainly marked, in good working order, and are unlocked and unobstructed when building is in use          
3. All fire doors and smoke doors are not restricted or blocked open by wedges, chains, or other props and are in good working order          
4. Fire alarms/detection equipment is in proper working order so that all occupants can hear/see audible alarm or visual signal and is utilized in fire drills          
5. Emergency numbers are posted by telephone          
6. Evacuation plan is posted in all areas          
7. Emergency exit lights are illuminated and exit signs are visible          
8. Emergency lighting is in operable condition          
9. Chemicals used for both instructional purposes and maintenance are labeled and stored in proper containers and location. Material Safety Data Sheets are available on campus for review of any hazardous material stored on premises          
10. Supplies such as oily rags, mops, etc., are stored in safe and orderly manner in a well-ventilated place or in an approved metal contained with self-closing lid          
11. Combustible liquids are stored in approved containers with vapor-tight covers in proper Locations            
Laboratory supplies          
12. All accumulations of trash and rubbish have been removed daily from all the buildings on the premises          
13. Portable fire extinguishers have been checked within past year by competent technician Yes   No    
14. Comments attached Yes   No    
15. Date last Principal’s Monthly Fire drill and Inspection Report was made as prescribed by G. S. 115C-525(b)           
16. Last fire safety inspection as prescribed by 115C-525(b) was conducted by (person) (date)  (Person)    (Date)    
17. Last electrical inspection as prescribed by 115C-525(b) was conducted by  (Person)    (Date)    
C. I certify that pursuant to G. S. 115C-525(b) (4), I have removed or corrected all fire hazards known to me, and/or that I have notified the Superintendent in writing of those hazards that I could not remove or correct (Copy attached)
Principal's Signature :
Superintendent’s Copy
Principal’s Copy