Monthly Fire Extinguisher Inspection

• Site conducted

  Select

• Conducted on

  Date

• Surveillance Month

• Prepared by

Fire Extinguisher No. 1

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 2

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 3

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 4

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 5

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 6

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 7

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 8

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 9

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 10

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 11

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 12

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 13

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 14

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 15

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

Fire Extinguisher No. 16

• Is the fire extinguisher unobstructed and accessible?

  Safe

  At Risk

  N/A

• Is the fire extinguisher safely secured/won't fall easily?

  Safe

  At Risk

  N/A

• Are the operating instructions on nameplate legible?

  Safe

  At Risk

  N/A

• Is the nozzle intact?

  Safe

  At Risk

  N/A

• Is pin intact?

  Safe

  At Risk

  N/A

• Is the anti-tamper seal intact?

  Safe

  At Risk

  N/A

• Does the gauge show in the green (Fully Charged)?

  Safe

  At Risk

  N/A

• Is the service company tag attached, signed and dated?

  Safe

  At Risk

  N/A

• Concerns Identified?

  Safe

  At Risk

  N/A

• Other Concerns Identified?

  Safe

  At Risk

  N/A

• Completed By:

  Sign