Title Page
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Site conducted
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Conducted on
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Surveillance Month
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Prepared by
Fire Extinguisher No. 1
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Is the fire extinguisher unobstructed and accessible?
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Is the fire extinguisher safely secured/won't fall easily?
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Are the operating instructions on nameplate legible?
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Is the nozzle intact?
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Is pin intact?
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Is the anti-tamper seal intact?
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Does the gauge show in the green (Fully Charged)?
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Is the service company tag attached, signed and dated?
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Concerns Identified?
Closeout
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Other Concerns Identified?
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Expiry Date
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Completed By: