Property Representative (Name, Phone #, Email )
Property Owner (Name, Phone #, Email )
Emergency Contact 1 (Name, Phone # )
Emergency Contact 2 (Name, Phone # )
Knox Box (if yes enter location)
Annunciator Panel (if yes enter location)
FDC (if yes enter location)
Gas Service (if yes enter location)
Electric Service Location
Special Hazards ( if yes list hazards)
Number of Stories Above Grade
Number of Stories Below Grade
- Heavy Timber
- Wood Frame
Sprinkler System installed?
- A - Assembly
- B - Business
- E - Educational
- F - Factory/Industrial
- H - High Hazard
- I - Institutional
- M - Mercantile
- R - Residential
- S - Storage
- U - Miscellaneuos
Occupancy Group Comments
Valid Occupancy Permit
Were alterations or renovations made since last inspection?
Were violations corrected at the time of inspection?
Is a follow-up inspection required?
# of days until follow up inspection?
Were violations corrected at the time of re-inspection?
Is Emergency Egress adequate for capacity
Are Fire Doors functioning properly?
Are the Exit Doors Locked?
Are the Exit Doors Blocked?
Are all exits visible, free from obstruction & ready for immediate use?
Are all exits & egress adequately lit?
Are Egress Pathways Clear & Unobstructed?
Is Emergency Lighting adequate, unobstructed & properly tested & maintained? (tested monthly)
Are doors equipped only with approved hold-open & self-closing devices?
Are Exits marked properly & exit signs unobstructed & properly maintained?
Is the sprinkler system maintained, tested & documented properly?
Are sprinkler heads unobstructed & free of debris?
Are the sprinkler riser & FDC free of obstructions?
Is the FDC properly marked & protective covers in place?
Sprinkler cabinet: spare heads & wrench present?
Is the fire alarm system maintained & inspected as per NFPA 72?
Is there a manual alarm system?
Are pull stations present, working & properly maintained?
Is the fire alarm system monitored? (required on group homes > 6 & daycares > 50)
Monitoring Company & Phone #?
- Smoke & CO
- CO only
- Rate of Rise
- Smoke & Heat
- Not Present
What type of alarm signals are present?
Are fire extinguishers correct for the application, unobstructed maintained as per NFPA 10?
Are fire extinguishers properly identified & hung on the wall?
Are walls & ceilings maintained in tact?
Is inside storage maintained in a safe manner; 24" below ceiling in non-sprinklered buildings, 18" below ceiling in sprinklered buildings?
Is the flammable/combustible liquid storage within code?
Are compressed gases stored & secured properly?
Is mechanical room free from combustible storage & a minimum 36" clearance maintained between heating equipment & storage?
Are utilities in good working order? (HVAC, Water, Electrical)
Are good housekeeping practices followed?
Does the building require any maintenance?
Are ceiling tiles in place?
Are balconies free from open-flame grills?
Are clothes dryers free from lint accumulations?
Fire extinguisher present?
Is the dryer properly vented?
Is the kitchen cooking area protected by a hood system?
Are all gas appliances properly protected by hood system?
Does the hood system need to be serviced? (require service every 6 months)
Is hood pull station properly identified and unobstructed?
Does the hood system need to be cleaned?
Are hood filters in place and properly fitted?
Is the area around electrical panels clear? (minimum clearance shall be 30"W x 76"H x 36"D)
Are there extension cords being used as permanent wiring?
Are there electrical hazards present? (open boxes, exposed wiring, open breakers)
Are outlets, switches, junctions boxes or panel boxes missing covers?
Are electric meters and panels properly labeled as to area serviced?
- 10 or more
Are fire doors self-closing?
Are the fire doors latching?
Are exit enclosures & egress free of storage?
Is emergency lighting present & working?
Is emergency lighting tested monthly?
Is there a written emergency plan?
Are evacuation plans properly posted?
Are fire drills conducted monthly
- 12 or more
Are tornado drills conducted?
Is clothing stored in corridors?
Are artworks & teaching materials on walls <20% of wall area?
Ad there UL approved smoke detectors on each level & in each sleeping area?
Is a fire extinguisher present in the cooking area? (minimum 2A-10BC)
Is the basement approved as an occupiable space? (must have 2 ways out)
Is the calendar of of fire drills approved?
Is the evacuation plan approved?
Is the facility reasonably free from hazards at the time of inspection?
Is the facility approved?
Violations Found (Number Violations)
Recommended Corrections ( Number corrections to correlate with violation)
For questions about this inspection please contact the Truro Township Fire Department Fire Prevention Bureau at (614) 729-1920.