G. P.

Shekhawati Hospital & Research Centre

Vidhyadhar Nagar, Jaipur (Rajasthan)

Facility Round Report

Date:

Department:

Sl. Points to be Checked Status Remarks

No
1 Public Addressable System Working Yes/No
Properly
2 All signage are properly fixed Yes/No
3 Any visible damage in signage Yes/No
4 Any loose wire visible Yes/No
5 Fire extinguisher available Yes/No
6 RACE & PASS pasted Yes/No
7 Fire Extinguisher easily accessible Yes/No
8 Date of refueling and date of expiry pasted Yes/No
on fire extinguisher
9 Does pressure point is in green zone Yes/No
10 Any visible damage to fire extinguisher Yes/No
11 Fire Exit clearly visible Yes/No
12 Any visible damage in Fire Exit Yes/No
13 Safety Belt in stretchers available Yes/No
14 Safety belt in wheel chair available Yes/No
15 Are cables are routed through conduits? Yes/No
16 Combustion items are placed far from Yes/No
potential source of fire
17 All electrical items are working in proper Yes/No
condition
18 Other fire fighting facility available Yes/No
(sprinklers, emergency light, smoke
detector, etc)

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 G. P. Shekhawati Hospital & Research Centre
Vidhyadhar Nagar, Jaipur (Rajasthan)

Facility Round Report

Sl. No Points to be Checked Status Remarks

19 If safety alarm inside lift working Yes/No

20 Disaster codes displayed Yes/No
21 Phone available to call in case of disaster Yes/No
22 Any blockage in access to stairways Yes/No
(people gathering/sitting at staircase)
23 Proper illumination available Yes/No
24 Any visible damage in/ on wall Yes/No
25 Any visible damage in/on ceiling Yes/No

Remarks:

Action to be taken (if required):

Round taken by:

Signature

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