Title Page
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Client / Site
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Location
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Conducted on
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Prepared by
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INSTRUCTIONS
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1. Start by filling out the necessary information.
2. Assess the following by answering:”Good, Fair or Poor” on the questions below.
3. Add photos, notes and identified defects by clicking on the paperclip icon.
4. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date.
5. Complete audit by providing digital signature.
6. Share your report by exporting as PDF, Word, Excel or Web Link -
Extinguishers present in the premise
- Water
- Foam
- Dry Powder
- Carbon Dioxide
- Wet Chemical
Water Extinguishers
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No. of Water Extinguishers
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Take a photo
Maintenance
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General Condition of the extinguishers mechanical parts
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General Condition of the extinguishers agent
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General Condition of the extinguishers expelling means
Foam Extinguishers
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No. of Foam Extinguishers
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Take a photo
Maintenance
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General Condition of the extinguishers mechanical parts
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General Condition of the extinguishers agent
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General Condition of the extinguishers expelling means
Dry Powder Extinguishers
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No. of Dry Powder Extinguishers
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Take a photo
Maintenance
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General Condition of the extinguishers mechanical parts
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General Condition of the extinguishers agent
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General Condition of the extinguishers expelling means
Carbon Dioxide Extinguishers
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No. of Carbon Dioxide Extinguishers
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Take a photo
Maintenance
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General Condition of the extinguishers mechanical parts
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General Condition of the extinguishers agent
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General Condition of the extinguishers expelling means
Wet Chemical Extinguishers
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No. of Wet Chemical Extinguishers
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Take a photo
Maintenance
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General Condition of the extinguishers mechanical parts
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General Condition of the extinguishers agent
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General Condition of the extinguishers expelling means
Summary and Completion
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Total Number of Extinguishers inspected within the premises. (Interior and Exterior)
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Total Number of Repaired Extinguishers
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Total Number of Replaced Extinguishers
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Overall comments of the 12 month inspections
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I hereby confirm that the Annual Fire Extinguisher Inspection was performed by an approved extinguisher servicing company.
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Name and Signature of Inspector
