Monthly Fire Extinguisher Inspection Form

• Client/Rig/Office/Shop/Location/Fire Extinguisher #

• Conducted on

  Date
• Location
  Address

Visual Inspections

• Add Fire Extinguisher to Inspect

Fire Extinguisher

• Date of Last Annual Inspection

• Date of Hydro Test

• Fire Extinguisher Location

  Vehicle

  BOS Equipment

  Shop

  Office

• 1. Free and clear access to fire extinguisher is maintained

  Yes

  No

  N/A

• 2. Extinguisher is in designated area

  Yes

  No

  N/A

• 3. Pin is in place and tab is not broken

  Yes

  No

  N/A

• 4. The charge indicator is in the full range (green)

  Yes

  No

  N/A

• 5. Fire extinguisher is still full (heavy to lift)

  Yes

  No

  N/A

• 6. No indication of physical damage (corrosion, leakage)

  Yes

  No

  N/A

• 7. Hose appears in good shape and nothing inside of the nozzle

  Yes

  No

  N/A

• 8. Monthly inspection noted on extinguisher tag

  Yes

  No

  N/A

• 9. Operating instructions are legible on the fire extinguisher

  Yes

  No

  N/A

• 10. Fire extinguisher has been turned 180 degrees to ensure chemical is not packed in the cylinder.

  Yes

  No

  N/A

• Competency Evaluation was Performed by:

  Select HSE Trainer Supervisor Mentor Field Tech Contractor Shop Tech

  • HSE
  • Trainer
  • Supervisor
  • Mentor
  • Field Tech
  • Contractor
  • Shop Tech

• Monthly fire extinguisher inspections are required. Visually inspect the fire extinguisher looking for broken parts, corrosion, or leakage. Ensure the fire extinguisher is fully charged by looking at the gauge and lifting it. Ensure access to the fire extinguisher is not blocked and there is signage to indicate where the fire extinguisher is located. Sign off the appropriate month you have inspected the fire extinguisher on the annual inspection label.

• Employee/Contractors Name

  Sign