Wood Burning Fireplace Inspection Report

• Site conducted

  Select

• Client Name

• Address
  Address

• Add media

  Media

• Inspection Date

  Date

• Prepared by (Full Name)

System Information

Fireplace

• Construction

  Factory-built

  Masonry

  Modular

  Other

• Please specify

• Heating appliance type

  Insert

  Freestanding

  Furnace

  N/A

• Fuel

  Wood

  Gas

  Coal

  OIl

• Opening size

• Hearth extension size

• Damper

• Firebox Condition

Chimney

• Construction

  Factory-built

  Masonry

  Modular

  Other

• Height

• Liner

  Flue tile

  Stainless

  Cast

  Unlined

  Other

• Size

• Last cleaning inspection

Inspection

Chimney

• Height

  Satisfactory

  Unsatisfactory

  N/A

• Chimney Cap / Spark Arrestor

  Satisfactory

  Unsatisfactory

  N/A

• Crown / Wash

  Satisfactory

  Unsatisfactory

  N/A

• Brickwork / Mortar

  Satisfactory

  Unsatisfactory

  N/A

• Flashing

  Satisfactory

  Unsatisfactory

  N/A

• Flue Liner

  Satisfactory

  Unsatisfactory

  N/A

• Moisture Resistance

  Satisfactory

  Unsatisfactory

  N/A

Fireplace

• Smoke Chamber

  Satisfactory

  Unsatisfactory

  N/A

• Damper

  Satisfactory

  Unsatisfactory

  N/A

• Hearth extension meets minimum requirements for opening size

  Satisfactory

  Unsatisfactory

  N/A

• Firebox / Grate

  Satisfactory

  Unsatisfactory

  N/A

• Clearance to combustibles

  Satisfactory

  Unsatisfactory

  N/A

• Mantle Clearance

  Satisfactory

  Unsatisfactory

  N/A

• Ash Container

  Satisfactory

  Unsatisfactory

  N/A

• Spark Screen / Doors

  Satisfactory

  Unsatisfactory

  N/A

Stove or Fireplace Insert

• Connector Pipe Condition

  Satisfactory

  Unsatisfactory

  N/A

• NFPA/IRC Approved Connection and Flue

  Satisfactory

  Unsatisfactory

  N/A

• Installation / Thimble / Clearances

  Satisfactory

  Unsatisfactory

  N/A

Other Safety Considerations

• Fire Ext. / Smoke Detectors / CO Alarms

  Satisfactory

  Unsatisfactory

  N/A

• Gas / Oil Furnace Flue Liner

  Satisfactory

  Unsatisfactory

  N/A

Completion

• Recommendations

• Inspector (Full Name and Signature)

  Sign