BUILDING INSPECTION SAFETY PROGRAM MANUAL A-200 INSTRUCTIONS A-200 Criminal Summons Court Case Record Date Issued: Approved by: Pages: 4 Purpose Scope This document explains how to complete an A-200 form. This directive applies to all personnel performing field inspections. Responsibilities and Procedures Fire Prevention Inspectors/Fire Department Issuing Officer must complete this form when issuing a criminal court summons. Supervisors must examine and sign completed forms. Instructions: Completing form A-200 WRITE CLEARLY AND LEGIBLY IN BLUE OR BLACK INK. 1. Docket No: For Criminal Court use only. Leave blank. 2. Summons No: Print the summons number exactly as it appears on the summons. (one digit inside each box) 3. Account No. Print the Fire Department account number (if applicable). (one digit inside each box only). 4. Initial Court Date: Print the initial appearance date specified on the summons, if personally served. 5. Issuing Unit: Print the unit which issued the summons. 6. Issuing Unit Telephone: Example: District Office 1, DO 1, Engine 10 or E 10. Print the telephone number (including area code) of the unit which issued the summons. 7. Name of Defendant: Print the full name of the individual or entity named on the summons. Do not shorten names or use initials. (Exception: Corp. & Inc.) Leave blank if process service is being requested through the Bureau of Legal Affairs. 8. a. Date of Birth: If individual is served, print the date of birth of the individual named on the summons, using the following format: mm/dd/yyyy. Leave blank if defendant is not an individual. b. Sex: Print the sex of the individual named on the summons (M-male or F-female). 9. Person /Entity Charged Is: Print the relationship to the premises of the defendant named on the summons. Example: Owner, lessee, officer, manager or authorized person in charge (APIC). 10. Method of Service: Print the method of service being used for this summons. Check only one method of service box: Personal check only if the individual named on the summons is the same individual who was physically served the summons.
Method of Service (cont d): 11. a. Address Where Violation Occurred: Corporation check when the entity named on the summons is a corporation (examples are: Corp., LLC, or Inc.) Give the name of the individual who was served the summons on behalf of corporation and corporate title of the individual, who must be one of the following: President Vice President Secretary of the corporation Treasurer or Assistant Treasurer Managing Agent An individual designated to accept service on behalf of the corporation. Partnership check when the entity named on the summons is a partnership (examples: LP or LLP). Give the name of the individual who was served the summons on behalf of the partnership. Give the title of the individual who was served on behalf of the partnership: A partner Managing agent An individual designated to accept service on behalf of the partnership. Note: DO NOT serve a person when a summons is issued to a corporation or partnership, unless you are certain that the person can be served. The person being served must be authorized to accept service on behalf of the entity. Request Service by Process Server Check this box when you cannot ensure service will be proper, as described above. Forward the summons for process service in accordance with the summons procedure as set forth in <AUC>. Note: This option may only be utilized after the Fire Department Issuing Officer exhausts the options described above. Print the building number and street name where the violation occurred. b. Boro: Print the borough: MN (Manhattan), BX (Bronx), BK (Brooklyn), QN (Queens), or SI (Staten Island). c. Zip Code: Print the zip code. d. Phone No. : Print the telephone number for the premises where the violation occurred (if available). 12. Type of Occupancy: Print the type of occupancy for the building where the violation occurred. Be specific. Refer to Chapter 3 of the Building Code. Institutional group hospitals, asylums, jails, correctional centers, etc. Assembly group theaters, auditoriums, ballrooms, restaurants, houses of worship, etc. Residential group multiple dwellings, hotels, dormitories, apartments, club houses, adult homes, etc. Business group banks, educational occupancies above 12 th grade, offices, laboratories, etc. 2
Industrial group chemical, food or ice cream factories, ice making plants, refineries, etc. Factory group bakeries, repair shops, dry cleaning establishments, laundries, etc. High hazard group explosives, flammable gases, oxidizers, corrosives, etc. Educational group academies, and schools up to the 12 th grade. Mercantile group department stores, sales rooms, motor fuel dispensing facilities, etc. Storage group furniture, cardboard, food products, etc. 13. # of Floors: Print the floor numbers in the building where the violation occurred. 14. Type of Business: Print the type of business operated by the individual or entity charged with violation. Example: Restaurant or MVRS. 15. Name of Business: (If Applicable) 16. Charging Section: Check only one box: 17. Section of Law Violated: Print the name of the business which is operating at the premises where the violation occurred. If more than one business, indicate the business which is primarily responsible for the violation. 15-216(a) and (b) an immediate summons for a violation enforceable by the Fire Commissioner. 15-223.1(a) and (b) failure to comply with a Fire Commissioner s Violation Order. Print the specific section(s) of law violated. FC3801.5 or R3404.01 18. a. Violation Order: If summons is for failure to comply, print the number of the Violation Order (VO), which was not complied with. b. Date VO issued: Print the date when the VO was issued if failure to comply charge was used. c. Person/Entity Named on VO: Print the individual/entity named on the VO (if applicable). 19. Offense Date: Print the date when you observed violation charged in the summons. 20. Violation Location: Print the exact part or portion of the building, room or other location, where the violation occurred. Example: Basement boiler room, 4 th floor hallway, etc. 21. Nature of Violation: Briefly describe the nature of the violation being charged on the summons. 22. Summary of Court Action: Smoking in factory. Locked factory exit on 3rd floor. Failure to obtain a Fire Department permit for the operation of the repair shop. Failure to have Fire Safety Director on duty in Class B occupancy. For Criminal Court use only. Leave blank. 3
23. Final Disposition: For Criminal Court use only. Leave blank. 24. Describe the Physical Condition Causing the Violation: 25. Is There Any Substance/ Equipment present requiring a Fire Department/Other Agency Permit: 26. A8/A110/A234 Referral Sent to : 27. Dates and Numbers of Previous Related Notice of Violations/ Violation Orders/ Summonses, If Any, Against Person or Entity Charged: 28. Remarks (Indicate Any Unusual Circumstances): 29. Served and Prepared by: Print a description of the physical condition causing the violation in detail. Be specific. Failed to provide adequate aisle space on the 3 rd floor that was leading to the exit. Sprinkler/standpipe system shut down throughout the building without notifying the dispatcher. Imminent fire hazard condition. Four (4) drapes in auditorium without flame proofing since 1995, presenting fire hazard to drapery and theatre. Print any substance/equipment present requiring a Fire Department or other agency permit. Be specific as to use, quantities and/or other characteristics relevant to permit requirements. Print the name and address of an agency and/or inspection unit where A-8 or A-234 was forwarded. Attach copies of the form. Print a list of dates and numbers of previous related Notice of Violations/Violation Orders/Summonses against the premises. List in date order with the most recent date first. Briefly describe the nature of each violation and summons and their outcome, if known. Print any unusual circumstances surrounding the issuance of this summons. Provide an explanation and attach any relevant documentation. Misleading or false representations or actions on the part of the defendant or defendant s representatives with respect to correcting the violation. Multi-agency task force operations or any involvement of the police or other agencies. Note: Threatening/abusive behavior on the part of the defendant must be reported to the police on Unusual Occurrence Report and Workplace Violence Incident Report. Attach copies of any such reports to the summons package, and a form if applicable. Completed by the Fire Department employee who served the summons. The employee must sign, print their name, title (Fire Protection Inspector, Supervising Inspector, Firefighter, etc.), unit, employee reference number or payroll management system (PMS) number and badge number. 30. Examined by: Completed by the Supervisor who has examined the work. Supervisors must print their name, title and unit. BY ORDER OF THE FIRE COMMISSIONER AND CHIEF OF DEPARTMENT 4
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