• Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Contact Information:

Fire Sprinkler Systems

  • Is this facility sprinklered?

  • Enter inventory for the following:

  • Wet sprinkler risers

  • Dry sprinkler risers

  • Floor Control valve assembly (not counted in riser count)

  • Antifreeze loops

  • Pre action systems

  • Deluge systems

  • Hose valves (outlet count including those on standpipes)

  • Standpipe riser count

  • Fire department connections (FDC)

  • Other Fire Sprinkler Information:

  • Last Annual Test Date

  • Photo

  • Has the facility conducted 5 year inspections?

  • Date of Last 5 Year Inspection:

Fire Pumps

  • Is the facility provided with a fire pump?

  • How many fire pumps are present?

  • Type of fire pump(s)

  • Size of fire pump(s)

  • Are any of the fire pumps located not at grade and /or require special provisions to test?

  • Please describe testing arrangements required

  • Other Fire Pump Information:

  • Last Annual Test Date

  • Photo

Water Storage Tanks

  • Is a fire water storage tank present at this site?<br>

  • Enter size and type of water storage tank

  • Last 5 Year Inspection

  • Photo

Fire Alarm System

  • Is a fire alarm system installed in this facility?

  • Panel Make / Model

  • Enter inventory for the following:

  • Manual Pull Stations

  • Smoke detectors

  • Heat Detectors

  • Heat detectors

  • Beam detectors

  • Duct detectors

  • Water flow switches (include all including riser)

  • Tamper switches (include all including riser, floor control and pump tampers)

  • Pressure switches (ie dry riser flows)

  • Horn

  • Horn / Strobe

  • Strobe

  • Bell

  • Other (list and describe)

  • Are all of the above devices accessible from the floor level or with maximum 20 ft test pole?

  • Describe what is not accessible from floor or with test pole:

  • Can sensitivity testing of smoke detectors be done by the panel or must it be manually tested?

  • Other fire alarm system information:

  • Last Annual Inspection

  • Photo

Portable Fire Extinguishers

  • Is client responsible for testing and inspection of portable extinguishers?

  • Enter number of portable extinguishers at facility:

  • Last Annual Inspection Date:

  • Photo

Backflow Preventors

  • Is client responsible for testing and inspection of Backflow preventers?

  • Enter number of Backflow preventers at facility:

  • Last Annual Inspection Date:

  • Photo

Kitchen Hood Systems

  • Are kitchen hood suppression systems installed at this facility?

  • Is client responsible for testing and inspection of kitchen hood suppression systems?

  • Enter number of kitchen extinguishing systems (control heads) at facility:

  • Enter total number agent bottles:

  • Enter total number links (if known):

  • Last Semi-Annual Inspection Date:

  • Photo

Emergency Lighting

  • Is client responsible for testing and inspection of emergency lighting?

  • Is the emergency lighting supplied by battery back up units or generator?

  • Enter number of battery lighting units at facility:

  • Are the lighting units in individual circuits (ie one or more dedicated breakers serve the emergency lighting) or mixed so each light is tested at the unit?

  • Enter number of generators at facility:

  • Last Annual Inspection Date:

  • Photo

Special Agent Suppression Systems

  • Is client responsible for testing and inspection of any clean / special agent systems?

  • Enter description of systems present:

  • Enter system configuration, number tanks, tank size etc.

  • Do any of these systems have a dedicated releasing panel?

  • Enter summary of devices on releasing panel:

  • Last Semi-Annual Inspection Date:

  • Photo

Facility Summary

  • Enter description of facility and operations:

  • How many buildings are included at this location under this report? Include proximity if multiple buildings are covered in this report.

  • What are operating hours of facility?

  • When can inspections be conducted and are there any restrictions?

  • Are there any security restrictions or access control features that can delay inspections?

  • Is any special training required for inspectors before entering this site?

  • Describe training required:

  • Enter facility drawing if available.

  • Site Photo

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.