Cross Streets

Cross Streets

Cross Streets

Cross Streets

Cross Streets

Fire Hydrant

First Hydrant

First Hydrant Number

Second Hydrant

Second Hydrant Number

Type Of Construction
Construction Type
Dimensions Of Building



Number Of Stories

Additional information:

Additional Comments:

Completed By
Fire Department Representative Signature:
Date Completed
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.