Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

  • VRC/Elevator(s) inspection certificate(s) up-to-date

  • Adequate number of portable fire extinguishers provided so that they are readily accessible in the case of an emergency

  • Portable fire extinguishers mounted, located and easily identifiable

  • Portable fire extinguishers visually inspected each month (There is an inspection card on all fire extinguishers that must be dated and initialed monthly)

  • Emergency stops/critical controls are identified


  • Any other comments?

  • When completed please provide signature here:

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