Title Page
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Local Registration #
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LHU Registration #
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Inspection Type
- Annual
- 1st Quarter
- 2nd Quarter
- 3rd Quarter
- 4th Quarter
- Complaint
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Inspection Date
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Inspector
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Business Name
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Business Address
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Business #
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Business Owner Name
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Business Owner Address
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Business Owner Phone #
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Use Group
- A
- B
- M
- R
- S
- F
- H
- U
- E
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LHU Code
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Email for NOV
Building Features
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Attic
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Roof Hatches
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Skylights
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Basement
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Square Footage of Basement
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Fire Escapes
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Condition of Fire Escape
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Fire Escape Issues
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Elevator
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Elevator Recall
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Elevator Inspection Records
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Elevator Last Insection Date
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# of Stories above Grade
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# Stories below Grade
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# of Exits Per Floor
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Total # of Exits
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Square Footage of Building
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Occupant Load
Fire Safety Permits
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Type of Fire Safety Permit
- None
- Type 1
- Type 2
- Type 3
- Type 4
- Type 5 - Reserved
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Reason for Fire Safety Permit
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Fire Safety Permits - Duration
Building Construction
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Floor Construction
- Concrete
- Wood
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Bearing Walls
- Concrete
- Block
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Ceiling
- Plaster
- Gypsum
- Wood
- Acoustic
- Metal
- Other
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Heating
- Oil
- Gas
- Electric
- Hot water
- Other
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Electric
- Fuses
- Circuit Breaker
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Wiring
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List Wiring Issues
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Roof Construction
- Concrete
- Rein. Concrete
- Wood
- Trusses
- Metal
- Other
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Emergency Generator
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Test Records
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Last Inspection Date
Fire Extinguishers & Special Hazards
Portable Fire Extinguishers
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Portable Fire Extinguishers
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Locations for Installation
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Fire Extinguisher Test Records
- Yes
- Yes- Overdue
- None
- New
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Condition of Fire Extinguishers
- Good
- Missing Pins
- Discharged
- Other Damage
Hood Suppression
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Hood Suppression Protection
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Hood Suppression Inspected
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Last Inspection Date
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Fire Protection Company Name and Phone #
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Other Special Hazard Protection
Exit & Emergency Lights
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Exit Signs
- None
- AC Powered
- Self Illuminating
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Working Condition
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Exit Signs Required (Retro-Fit)
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Location of Required Exit Signs
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Emergency Lights
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Working Condition
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Exit & Emergency Light Test Records
Fire Detection
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Fire Detection System
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Alarm Type of Fire Detection
- Local
- Central Station
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Type of Local Fire Detection
- 120V Smoke Alarm - Interconnection
- 120V Smoke Alarm - Single Station
- Smoke Alarm - Battery
- 120V Heat Detector
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Local Fire Detection in Working Order
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Central Station Fire Alarm Devices
- Pull Station
- Horn Strobe
- Smoke Detector
- Heat Detector
- CO2 Detection
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Last Inspection Date
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Fire Protection Company Info - Fire Alarm
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Fire Alarm Inspection Reports
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Carbon Monoxide Detection
- 120V Hardwired
- 10 Year Sealed Battery
- Battery Operated
- Monitored
- AC Plug In
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Battery Maintained?
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CO Monoxide Tested
Sprinkler System & Fire Pump
Sprinkler System
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Sprinkler System
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Location Sprinkler is Required
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Location of Sprinkler System
- Full
- Basement
- Partial
- Spraybooth
- N/A
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Sprinkler System Alarm Type
- Local
- Central Station
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Last Inspected of Sprinkler System
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Fire Protection Contractors- Name & Number
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Sprinkler System Test Records
Fire Pump
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Fire Pump
- None
- Electric
- Diesel
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Test Records
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Fire Pump Last Inspection Date
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Same Contactor as Sprinkler System
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Fire Pump Test Frequency
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Same Fire Protection Contractor as Sprinkler
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Fire Pump - Fire Protection Contractor Info
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Fire Pump - FDC
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Test Records
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Last Inspection of Fire Pump FDC
Standpipe System
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Standpipe
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Type of Standpipe
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Standpipe Test Records
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Standpipe Alarm Type
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Condition of Standpipes
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List Standpipe Corrections
Hazardous Materials
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Any Hazardous Materials Present
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SDS Present
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SDS Updated
Knox Box
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Knox Box
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Contact Fire Marshal
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Location of Box
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Tested Keys
Inspectors Notes
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List Corrections From Inspection
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# of Maintenance Violations
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# of Retrofit Violations
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