Northside Hospital Fire Door Inspection

• Document No.

• Fire and Smoke Door Inspection

• Northside Hospital Systems

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fire or Smoke Door

• Fire Door

• Smoke Door

• Rating (hr/min):

• Door Location

• Door Number

Fire and Smoke Door Inspection

• 1. Is the door damaged or missing parts?

  Yes

  No

  N/A

• 2. Are the open holes or breaks in the surface of the door or door frame?

  Yes

  No

  N/A

• 3. Does the Door have a glass panel and is it appropriately labeled?

  Yes

  No

  N/A

• 4. Does the door close on it own and latch properly?

  Yes

  No

  N/A

• 5. Is the door hardware damaged?

  Yes

  No

  N/A

• 6. Does the door have any auxiliary items attached to the door or the door frame?

  Yes

  No

  N/A

• 7. Does the door or frame have any field modifications?

  Yes

  No

  N/A

• 8. Does the door coordinator allow the inactive leaf to close before the active leaf?

  Yes

  No

  N/A

• 9. Does the bottom clearance for the door exceed 3/4"?

  Yes

  No

  N/A

• 10. If chains or cables are being used are they overly stretched or show excessive wear?

  Yes

  No

  N/A

• 11. Does the door show signs of dry rot?

  Yes

  No

  N/A

• 12. Does the door and frame have an identifiable fire or Smoke Door label?

  Yes

  No

  N/A

• 13. Has the Fire Door, Smoke Door, or Frame label been painted or visibly obscured?

  Yes

  No

  N/A

• Unit/Floor Manager or Supervisor

  Sign

• Life Safety Compliance Inspector

  Sign