Title Page
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Site conducted
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Conducted on
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Prepared by
- Portable Fire Equipment
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Portable Fire Equipment Type
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Fire Extinglisher Type
- Water
- Carbon Dioxide(CO2)
- Dry Chemical Powder(DCP)
- Foam
- Wet Chemical
- Fire Blanket
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Location
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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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Is Fire Extinglisher Handle 900-1200mm From The Ground, Base Of Extinglisher Not Less Then 100mm From Ground
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Sinage Indicator At Least 2000mm Above Floor Level
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Are the operating instructions on nameplate legible?
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Is the nozzle intact?
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Is Safety 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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Is There Damage to Extinglisher or Hose?
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Equipment Condition Outcome
Closeout
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Other Concerns Identified?
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Completed By:
