Portable Extinguisher Certificate of Inspection

• We hereby certify that the fire extinguishing appliances as set out below have been serviced in accordance with BS5306:3:2017 with the results indicated

• Document No.

• Customer

• Site Address
  Address

• Date

  Date

• Arrival Time

• Maintenance Type

  All Inclusive

  Standard Contract

Schedule Of Equipment

• Water Extinguisher

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity

• Extended Service Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Foam Extinguisher

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity

• Extended Service Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Dry Powder Extinguisher

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity

• Extended Service Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Carbon Dioxide Extinguisher

• Inspection Details

  Select Good Overhaul / Pressure Tested Recharged Unserviceable

  • Good
  • Overhaul / Pressure Tested
  • Recharged
  • Unserviceable

• Good Quantity

• Overhaul / Pressure Test Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Wet Chemical Extinguisher

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity

• Extended Service Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Lithex Extinguisher

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity

• Extended Service Quantity & Size

• Recharged Quantity & Size

• Unserviceable Quantity

• Fire Hose

• Inspection Details

  Select Good Unserviceable

  • Good
  • Unserviceable

• Good Quantity

• Unserviceable Quantity

• Fire Blankets

• Inspection Details

  Select Good Unserviceable

  • Good
  • Unserviceable

• Good Quantity

• Unserviceable Quantity

• Other

• Inspection Details

  Select Good Extended Service Recharged Unserviceable

  • Good
  • Extended Service
  • Recharged
  • Unserviceable

• Good Quantity, Type & Size

• Extended Service Quantity, Type & Size

• Recharged Quantity, Type & Size

• Unserviceable Quantity, Type & Size

• E/Service = Extended Service. Overhaul = Overhaul/Pressure Tested. U/S = Unserviceable.

Special Remarks & Parts used

• Are all Extinguishers either wall mounted on Brackets or Extinguisher Stands

  Yes

  No

• Action Required and Location

• Is there adequate provision of Portable Fire Extinguishers

  Yes

  No

• List of additional extinguisher required and location

• Parts Used (Standard Contract Only)

• Disposal of Fire Extinguisher

  Yes

  No

• Quantity & Type

• Waste Transfer note number

• Are all Extinguisher locations and type clearly marked with Identification Signs

  Yes

  No

• Location & ID sign required

• Has the log book been updated

  Yes

  No

• Action Required

• Is a Fire risk assessment available

  Yes

  No

• Next Maintenance Inspection due

  Date

• Apart from the non-conforming extinguishers as recorded, all fire extinguishers have been inspected and serviced in accordance with BS 5306: Part 3: 2017

Signature

• Engineer Signature

  Sign

• Customer Signature

  Sign

• Position

• BS5306:3:2017 11.2 Inspection by the user. It is recommended that the user carry out regular visual inspections of all extinguishers. The frequency of inspections by the user should be not less than monthly and when circumstances require, inspections should be carried out more frequently