Home Fire Safety Inspection

Inspection Location

• Name:

• Address:
  Address

• Select date

  Date

Consent to Inspection

• By signing below, I acknowledge that I have the authority to consent to an inspection at the above mentioned location. I hereby consent to an inspection conducted by Kaufman Fire Department personnel at the above mentioned location.

• Signature of Consent:

  Sign

• Position:

  Tenant

  Owner

Inspection Items

• Address posted on front of residence, visible from the street, in a minimum of 4" numbers.

  Yes

  No

  N/A

• Smoke detectors located in each bedroom and in corridors outside each bedroom.

  Yes

  No

  N/A

• Smoke detectors located at each floor level of the residence.

  Yes

  No

  N/A

• All electrical plugs and switch covers in place.

  Yes

  No

  N/A

• All covers on breaker boxes, interior and exterior, are in place.

  Yes

  No

  N/A

• Breakers must be labeled as to what they control and must be listed on the panel cover.

  Yes

  No

  N/A

• Minimum of one window in each bedroom that is capable of being opened in an emergency.

  Yes

  No

  N/A

• Exit doors are free from any double-keyed deadbolt locks.

  Yes

  No

  N/A

• All gas outlets that are not connected to an appliance are capped off in an approved manner.

  Yes

  No

  N/A

• All gas service lines are not copper.

  Yes

  No

  N/A

• Water heater location:

  Bedroom

  Bathroom

  Garage

  Other

• Type of water heater:

  Natural Gas

  Electric

• Water heater is vented through the roof.

  Yes

  No

  N/A

• Water heater must be enclosed in closet.

  Yes

  No

  N/A

• Combustion vent must be installed.

  Yes

  No

  N/A

• Type of water heater:

  Natural Gas

  Electric

• Water heater is vented through the roof.

  Yes

  No

  N/A

• Water heater must be enclosed in closet.

  Yes

  No

  N/A

• Combustion vent must be installed.

  Yes

  No

  N/A

• Water heater minimum of 18 inches above floor level.

  Yes

  No

  N/A

• Water heater pop-off valve is piped to the floor/drain.

  Yes

  No

  N/A

• Does residence have central heating and air conditioning?

  Yes

  No

  N/A

• Screens installed on all windows.

  Yes

  No

  N/A

• All windows have intact, non-broken glass.

  Yes

  No

  N/A

• Approved means of heating the residence.

  Yes

  No

  N/A

• All electrical fixtures are intact.

  Yes

  No

  N/A

• Ceiling and walls are intact, free of any holes.

  Yes

  No

  N/A

• Residence is free from any signs of insects or rodents?

  Yes

  No

  N/A

• Proof of extermination is provided.

  Yes

  No

  N/A

• Central air units located outside have an electrical disconnect next to the unit.

  Yes

  No

  N/A

• Residence is free of any exposed electrical wiring.

  Yes

  No

  N/A

Inspection Information

• Inspector

  Select W. Ballard #959 C. Vance #958 K. McAfee #961 Z. Starek #960

  • W. Ballard #959
  • C. Vance #958
  • K. McAfee #961
  • Z. Starek #960

• Date & Time of Inspection

  Date

• Date & Time of Re-inspection.

  Date

• Inspection Status:

  Finaled

  Pending

Tenant/Owner Information

• Phone Number:

• Email Address:

• Signature:

  Sign