Title Page

  • Document No.

  • Fire and Smoke Door Inspection

  • Northside Hospital Systems

  • Conducted on

  • Prepared by

  • Location
  • 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?

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

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

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

  • 5. Is the door hardware damaged?

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

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

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

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

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

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

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

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

  • Unit/Floor Manager or Supervisor

  • Life Safety Compliance Inspector

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