Monthly Fire Prevention Inspection Report

• Site conducted
  Address

• Conducted on

  Date

• Prepared by

• Picture of location

  Media

• Previous Inspection

  Date

Outside

• Address Visible

  Yes

  No

  N/A

• Are All Fire Exits in the building unobstructed and safe?

  Yes

  No

  N/A

• Are all final fire exits able to be opened fully?

  Yes

  No

  N/A

Inside

• Are All Fire Exits in the building unobstructed and safe?

  Yes

  No

  N/A

• Are all final fire exits able to be opened fully?

  Yes

  No

  N/A

• Are Fire Doors in good condition?

  Yes

  No

  N/A
Fire Extinguishers

• 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
Emergency Lights

• Emergency light brand/ model and Lamp type?

• Does the emergency light have Mains power available?

  Yes

  No

  N/A

• Does the emergency light require replacing?

  Yes

  No

  N/A

• Did the emergency light pass its test requirements?

  Yes

  No

  N/A
Exit Signs

• Location

• Type of Exit Sign

  illuminated

  Non illuminated

• is the light Active

  Yes

  No

  N/A
Smoke and Carbon Monoxide Detectors

• Location

• Detector Type

  Smoke Detector only

  Smoke and Carbon Monoxide

  Carbon Monoxide Only

• Is the smoke detector securely fastened to the wall or ceiling?

  Yes

  No

  N/A

• Does the smoke detector show no evidence of physical damage, paint application, or excessive grease and dirt accumulations?

  Yes

  No

  N/A

• What is the expiration date of the smoke detector's battery?

  Date

• Does the battery need replacement?

  Yes

  No

• Has the detector passed the operational test procedures?

  Yes

  No

  N/A

• Does the Detector need replacement

  Yes

  No

• Other Concerns Identified?

  Safe

  At Risk

  N/A

• Time Completed

  Date

• Completed By:

  Sign