College:__________________________    Entry: _____    Floor: _____   Room: _______
 1.  Smoke Detector:  Inoperative (   ) Damaged (   ) Missing (   )
 Each suite occupant will be fined $100.00
 2.  Door Self Closure: Inoperative (   ) Damaged (   ) Other (   )________
 Each suite occupant will be fined $100.00
 3.  Door Security Alarm: Inoperative (   )Tampered (   ) Other (   )________
 Each suite occupant will be fined $100.00
 4.  Emergency Fire Door: Blocked (   ) Inoperative (   ) Damaged (   )
 Each suite occupant will be fined $100.00
 5.  Flammable/Combustible Materials: Trash (   )Tapestries (   ) Candles/Lamps (   )
 Each suite occupant will be fined $100.00
 6.  Unauthorized Appliances: Hot Plates/ Pots (   ) Microwave (   ) Toaster/Oven (   )
 Heaters (   ) Cooking Equipment (   ) Halogen Lamps (   ) Other (   )______________
 Each suite occupant will be fined $100.00
 8.  Overloaded Outlets/ Extension Cords:   Yes (   ) No (   )
 9.  Items on or Blocking Fire Equipment: (   )______________________________
 10. Room/ Suite Clutter or Fire Hazard:   (   )Correct by:_____________________
 Each suite occupant will be fined $50.00

All Fire or safety hazards MUST be corrected and students MUST schedule a reinspection of their room with the Office of the Fire Marshal within five (5) working days. This form MUST be completed and returned to our office or fines will be imposed. Failure to correct Fire Safety violations will result in disciplinary action as outlined in the Undergraduate Regulations. All fire or safety questions should be addressed to the Office of the Fire Marshal at 432-9923. All Custodial questions should be addressed to the area Custodial Supervisor.
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Custodial Inspection Report:
All furniture must be in the assigned room by the first week of May. Any item deemed missing will be assessed at the following rates:
Desk $280.00 (   ) Bureau $280.00 (   ) Bed $200.00 (   ) Chair $75.00 (   )
Mattress $100.00 (   ) Recycling Bin $10.00 (   )
Drapes/Rods $45.00 per window (   )

 TOTAL CUSTODIAL CHARGE $___________________
 Room Painting: If the walls or ceiling is painted anything but Yale white, they must be repainted
 before you vacate the room. There will be a Bursar Billed fine of $100.00 per wall/ceiling, plus any clean
 up or repair costs.
 ALL STUDENTS must sign and write ssn #s below and return to the OFFICE OF THE FIRE MARSHAL at 314 Prospect Street or fines will be imposed.

 ________________________________________        _____________________________________
 

 ________________________________________        _____________________________________
 Student Signatures and Social Security #'s

 _______________________________________            ______________
 Supervisors Name      Date of Inspection
 Notes:_______________________________________________________________________________

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 Dist: White-Occupant: Yellow-Fire Marshal; Pink-Custodial; Goldenrod-Master  rev. 04/98