Title Page

  • Business Name

  • Location
  • Date of Inspection

  • Inspector

Plans / Drawings

  • Verify approved plans / drawings are on-site or are available to the contractor.

Visual Inspection

  • Door swings in the direction of egress.

  • Emergency lighting is provided at all egress doors.

  • “Push to Exit” button is installed, readily visible / accessible, and labeled.

Operational Test

  • Door releases upon fire alarm activation.

  • Door releases upon loss of power to the lock or locking mechanism.

  • Door releases upon pressing of “Push to Exit” button.

  • Door releases upon pressing override switch, if applicable.

  • Door releases upon activation of motion sensor.

Delayed Egress

  • Door is labeled “PUSH UNTIL ALARM SOUNDS - DOOR CAN BE OPENED IN 15 SECONDS”

  • An irreversible process after release device is pressed for 1 second and door unlocks within 15 seconds (manual reset).

Inspection Status

  • Inspection Status

  • Next Inspection

  • Owner / Representative

  • Phone #

  • Email Address

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.