Title Page
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Conducted on
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Prepared by
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Location
Shelf extinguishers (spares)
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Are the gauges in the acceptable range?
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Are the hoses in good condition?
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Were the units turned over 3 times?
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Did any units fail?
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How many units failed what actions were taken?
Inside #1
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Inside #2
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Inside #3
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Inside #4
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Inside #5
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Inside #6
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Forklift
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Outside #1
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Outside #2
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Is the extinguisher clear of obstructions?
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Is the gauge in the acceptable range?
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Is the hose in good condition?
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Was unit turned upside down 3 times
Signature
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Signature
