Title Page

  • Site conducted

  • Conducted on

  • Surveillance Month

  • Prepared by

Fire Extinguisher No. 1

  • Is the fire extinguisher unobstructed and accessible?

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

  • Are the operating instructions on nameplate legible?

  • Is the nozzle intact?

  • Is pin intact?

  • Is the anti-tamper seal intact?

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

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

  • Concerns Identified?

Closeout

  • Other Concerns Identified?

  • Expiry Date

  • Completed By:

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