Title Page

  • Site conducted

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel

  • Add location
  • EXTINGUISHER (Ref OSHA 1910.157 for details)

  • EXTINGUISHERS
  • What is the Extinguisher Number?

  • Photo

  • LOCATION
  • If on a Vehicle or Equipment ( Equipment Number)

  • Mounting Type

  • Access to Extinguisher ( Clear on all sides )

  • Label & Instructions

  • Safety Seal / Pin Seal

  • Extinguisher Gauge

  • Extinguisher Full

  • Physical Condition

  • INSPECTION LEVEL COMPLETED?

  • Add signature

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