Fire Inspection Report

• Local Registration #

• LHU Registration #

• Inspection Type

  Select Annual 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Complaint

  • Annual
  • 1st Quarter
  • 2nd Quarter
  • 3rd Quarter
  • 4th Quarter
  • Complaint

• Inspection Date

  Date

• Inspector

• Business Name

• Business Address
  Address

• Business #

• Business Owner Name

• Business Owner Address
  Address

• Business Owner Phone #

• Use Group

  Select A B M R S F H U E

  • A
  • B
  • M
  • R
  • S
  • F
  • H
  • U
  • E

• LHU Code

• Email for NOV

• Attic

  Yes

  No

• Roof Hatches

  Yes

  None

• Skylights

  Yes

  None

• Basement

  Yes

  No

• Square Footage of Basement

• Fire Escapes

  Yes

  None

• Condition of Fire Escape

  Good

  Requires Maintenance

• Fire Escape Issues

• Elevator

  Yes

  None

• Elevator Recall

  Yes

  No

• Elevator Inspection Records

  Yes

  No

  No Required

• Elevator Last Insection Date

  Date

• # of Stories above Grade

• # Stories below Grade

• # of Exits Per Floor

• Total # of Exits

• Square Footage of Building

• Occupant Load

• Type of Fire Safety Permit

  Select None Type 1 Type 2 Type 3 Type 4 Type 5 - Reserved

  • None
  • Type 1
  • Type 2
  • Type 3
  • Type 4
  • Type 5 - Reserved

• Reason for Fire Safety Permit

• Fire Safety Permits - Duration

  Annual

  Temporary

• Floor Construction

  Select Concrete Wood

  • Concrete
  • Wood

• Bearing Walls

  Select Concrete Block

  • Concrete
  • Block

• Ceiling

  Select Plaster Gypsum Wood Acoustic Metal Other

  • Plaster
  • Gypsum
  • Wood
  • Acoustic
  • Metal
  • Other

• Heating

  Select Oil Gas Electric Hot water Other

  • Oil
  • Gas
  • Electric
  • Hot water
  • Other

• Electric

  Select Fuses Circuit Breaker

  • Fuses
  • Circuit Breaker

• Wiring

  Good

  Requires Maintenance

• List Wiring Issues

• Roof Construction

  Select Concrete Rein. Concrete Wood Trusses Metal Other

  • Concrete
  • Rein. Concrete
  • Wood
  • Trusses
  • Metal
  • Other

• Emergency Generator

  No

  Yes - Emergency

  Yes- Optional

• Test Records

  Yes

  No

• Last Inspection Date

Portable Fire Extinguishers

• Portable Fire Extinguishers

  Yes

  None

• Locations for Installation

• Fire Extinguisher Test Records

  Select Yes Yes- Overdue None New

  • Yes
  • Yes- Overdue
  • None
  • New

• Condition of Fire Extinguishers

  Select Good Missing Pins Discharged Other Damage

  • Good
  • Missing Pins
  • Discharged
  • Other Damage

Hood Suppression

• Hood Suppression Protection

  Yes

  None

  None- Required under Retro-Fit

• Hood Suppression Inspected

  Yes

  Overdue for Inspection

• Last Inspection Date

• Fire Protection Company Name and Phone #

• Other Special Hazard Protection

• Exit Signs

  Select None AC Powered Self Illuminating

  • None
  • AC Powered
  • Self Illuminating

• Working Condition

  Yes

  Needs Repairs

• Exit Signs Required (Retro-Fit)

  Yes

  No

• Location of Required Exit Signs

• Emergency Lights

  Yes

  None

• Working Condition

  Good

  Needs Repairs

• Exit & Emergency Light Test Records

  Yes

  None

  N/A

• Fire Detection System

  Yes

  No

  No - Required under Retrofit

• Alarm Type of Fire Detection

  Select Local Central Station

  • Local
  • Central Station

• Type of Local Fire Detection

  Select 120V Smoke Alarm - Interconnection 120V Smoke Alarm - Single Station Smoke Alarm - Battery 120V Heat Detector

  • 120V Smoke Alarm - Interconnection
  • 120V Smoke Alarm - Single Station
  • Smoke Alarm - Battery
  • 120V Heat Detector

• Local Fire Detection in Working Order

  Yes

  Needs Maintenance

• Central Station Fire Alarm Devices

  Select Pull Station Horn Strobe Smoke Detector Heat Detector CO2 Detection

  • Pull Station
  • Horn Strobe
  • Smoke Detector
  • Heat Detector
  • CO2 Detection

• Last Inspection Date

• Fire Protection Company Info - Fire Alarm

• Fire Alarm Inspection Reports

  Yes

  No

• Carbon Monoxide Detection

  Select 120V Hardwired 10 Year Sealed Battery Battery Operated Monitored AC Plug In

  • 120V Hardwired
  • 10 Year Sealed Battery
  • Battery Operated
  • Monitored
  • AC Plug In

• Battery Maintained?

  Yes

  Needs Replacement

• CO Monoxide Tested

  Yes

  No

Sprinkler System

• Sprinkler System

  Yes

  No

  No - Required Under Retrofit

• Location Sprinkler is Required

• Location of Sprinkler System

  Select Full Basement Partial Spraybooth N/A

  • Full
  • Basement
  • Partial
  • Spraybooth
  • N/A

• Sprinkler System Alarm Type

  Select Local Central Station

  • Local
  • Central Station

• Last Inspected of Sprinkler System

• Fire Protection Contractors- Name & Number

• Sprinkler System Test Records

  Yes

  No

Fire Pump

• Fire Pump

  Select None Electric Diesel

  • None
  • Electric
  • Diesel

• Test Records

  Yes

  No

• Fire Pump Last Inspection Date

• Same Contactor as Sprinkler System

  Yes

  No

• Fire Pump Test Frequency

  Weekly

  Monthly

  Quartely

  Annually

• Same Fire Protection Contractor as Sprinkler

  Yes

  No

• Fire Pump - Fire Protection Contractor Info

• Fire Pump - FDC

  Yes

  None

• Test Records

  Yes

  No

• Last Inspection of Fire Pump FDC

• Standpipe

  Yes

  None

  No - Required under Retro-Fit

• Type of Standpipe

  Wet

  Dry

• Standpipe Test Records

  Yes

  No

• Standpipe Alarm Type

  Local

  Central Station

• Condition of Standpipes

  Good

  Required Maintenance

  N/A

• List Standpipe Corrections

• Any Hazardous Materials Present

  Yes

  No

• SDS Present

  Yes

  No

• SDS Updated

  Yes

  No

• Knox Box

  Yes

  No

  Missing

• Contact Fire Marshal

• Location of Box

• Tested Keys

  Yes- Works

  No

  Need to Update Keys

• List Corrections From Inspection

• # of Maintenance Violations

• # of Retrofit Violations

• Add signature

  Sign