Monthly Report for Certified Desk Clerks

Chicago Fire Department

Bureau of Fire Prevention

Monthly Report of Certified Desk Clerks



A copy of this form with the required information is to be forwarded before the fifth day of each month to the Deputy Fire Commissioner of the Bureau of Fire Prevention, 444 North Dearborn Street, Chicago, IL 60610.  The duplicate thereof shall be retained by the owner/manager of the public sleeping accommodation where such desk clerk is employed. (Please type or print legibly.)



Name of Hotel: ____________________________                             Phone Number: ________________________

Address: ______________________________                      Date: _____________           Time: ___________

Please answer the following questions.

  1. Are the basement, attic, storerooms and the entire premises free of rubbish and unnecessary combustibles? ______________________
  2. Are the corridors and fire escapes free of all obstructions? ______________
  3. Are all exit doors unlocked and unobstructed? ________________
  4. Are all exit ways illuminated? _________________
  5. Are all exit and fire escape signs kept lighted at all times? _____________
  6. Are all stairway doors, boiler room doors and basement doors kept closed? _________________
  7. Are all fire appliances in their proper place and in good working order? ________________
  8. Do you know how to call the fire department? (911) _______________
  9. Is the building equipped with a fire alarm system? _______________
  10. Do you know the location and operation of the fire alarm boxes within your building? _________
  11. Is the fire alarm system in good working order? _________________
  12. Is there any special hazard? _____________

Remarks: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Desk Clerk: _________________________________                       Manager: ___________________________

(Printed)                                                                                                                                                                                 (Printed)


                                                                                                                                     ________________________________                       __________________________

           (Signature)                                                                                                                                                                  (Signature)


F.D. 415   ( 3/14/06)

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