Smoke Detector Inspection Checklist

• Conducted on

  Date

• Prepared by

  Steven Lowry

  Bradley Gilbert

  Brent Ponsold

  Angus Brebner

  Richard Bevilacqua

• Property address:

Room/Unit

• Location

• Serial Number

• Is the smoke detector securely fastened to the wall or ceiling?

  Yes

  No

  N/A

• Does the smoke detector show evidence of physical damage, paint application, or excessive grease and dirt accumulations?

  Yes

  No

  N/A

• What is the expiration date of the smoke detector's battery?

  Date

• Does the battery need replacement?

  Yes

  No

  N/A

• Date Replaced

  Date

• Who performed the replacement?

Testing of Detectors

• Have all Smoke Detectors in the installation been tested?

  Yes

  No

  N/A

• How many Smoke Detectors were tested?

• Have all detectors that were tested passed the operational test procedures?

  Yes

  No

  N/A

• Type of smoke alarms installed at property?

  Mains voltage

  9 volt Battery

  10 year battery

• Have all Smoke Detectors that failed the tests been replaced?

  Yes

  No

  N/A

• Is any further action required to meet compliance of these installations

  Yes

  No

  N/A

Next Due Date for Smoke Detector Inspection

• Your next test is due on:

  Date

Confirmation

• Further to the installation of smoke detectors at the listed address above, this compliance certificate is to confirm the installation of smoke detectors and state their installation and operational compliance.

• Full Name and Signature of Inspector

  Steven Lowry

  Bradley Gilbert

  Brent Ponsold

  Angus Brebner

  Richard Bevilacqua