BOP Program Statement 1600.16 § 22

a. Weekly Inspections. Weekly fire protection and life safety inspections must be conducted

by the IDO. Specific items covered must be outlined in the institution’s Fire Plan.

b. Monthly Inspections. The SA ensures monthly fire protection and life safety inspections are

conducted. Specific items covered must be outlined in the Fire Plan.

c. Outside Fire Agency Visits. An invitation to conduct a courtesy visit must be extended to

responding fire agencies annually. Any outside fire agency recommendations should be reviewed

by the SA and implemented, if practical.

d. Annual Inspection. An annual fire protection and life safety inspection must be conducted

by one of the following:

 SA

 RSA

 Central Office Occupational Safety and Health Branch staff

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e. Fire Alarm System Inspections. Alarm systems must be inspected, tested, and maintained

in accordance with NFPA 72, by qualified Facilities staff or an outside contractor.

f. Sprinklers, Standpipes, Hydrants, Tanks, and Other Water-Based Extinguishing System

Inspections. Water-based extinguishing systems must be inspected, tested, and maintained per

NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire

Protection Systems by qualified Facilities staff or an outside contractor.

In addition to the tests specified in NFPA 25, quarterly main drain tests must be conducted by

qualified Facilities staff or a qualified outside contractor on all sprinkler risers.

An annual sprinkler inspection must be conducted by a qualified outside contractor. Other

inspections and tests may be conducted by qualified Facilities staff.

Any time a sprinkler system control valve is closed, a main drain test must be conducted as soon

as the valve is re-opened.

g. Fire Hydrant Test. Fire hydrants on institution property must be flow-tested annually. Tests

must be conducted by qualified Facilities staff or an outside contractor.

h. Underground and Exposed Piping Test. A full flow test of underground and exposed

piping serving fire hydrants must be conducted at least every five years. Tests must be

conducted by qualified Facilities staff or an outside contractor.

i. Kitchen Hood and Duct System Inspection. Exhaust systems, along with associated fixed

fire suppression systems, must be inspected, tested, and maintained in accordance with NFPA 96,

Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations.

j. Portable Fire Extinguisher Inspection. Extinguishers must be inspected, tested, and

maintained in accordance with NFPA 10, Standard for Portable Fire Extinguishers. Annual

maintenance/inspection must be conducted by a certified staff member or contractor.

k. Halon Extinguishing System. Existing Halon 1301 systems must be inspected, tested, and

maintained in accordance with NFPA 12A, Standard on Halon 1301 Fire Extinguishing Systems.

 Portable Extinguishers. Portable Halon fire extinguishers are not permitted

 Fixed Halon Systems. New fixed Halon fire suppression may not be installed

l. Inspection Records. Inspections must be documented by a written report:

 Weekly/Monthly Inspections. Written reports of weekly and monthly inspections,

including deficiencies, must be sent to the Department Head and forwarded to the

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Warden, through the Associate Warden, for review and corrective action, if needed. The

reports and corrective actions taken must be kept in the Occupational Safety & Health

Department for three years.

 Fire Alarm/Suppression Inspections. Inspection, testing, and maintenance records for

fire detection, alarm, and suppression equipment must be kept for three years.

 Hydrostatic Testing. Records of hydrostatic testing must be kept until the next test.

m. SCBA. SCBA must be inspected, tested, and maintained as follows:

 Monthly inspection by Occupational Safety and Health Department staff

 Annual inspection by a manufacturer’s authorized service representative

 Annual regulator flow test by a manufacturer’s authorized service representative

 Air cylinders must be re-tested in accordance with the appropriate U.S. Department of

Transportation (DOT) specification or the applicable DOT exemption.

 Carbon fiber air cylinders must be re-tested every five years

 Carbon fiber air cylinders have a maximum 15-year or 30-year service life depending

on the model

 Inspection, testing, and maintenance records must be maintained by the Occupational

Safety and Health Department