Self-Inspection Form Home Departments Fraternity & Sorority Life Fire Safety Self-Inspection Form Self-Inspection Form Name * Email Address * Chapter * Was the sprinkler system inspected within last 12 months without problems and is currently operable? * Yes No Are there spare sprinkler heads in the box along with wrench? * Yes No Was the Fire Alarm System inspected within last 12 months and has no trouble alarms showing, operable, and panel is accessible? * Yes No There are no blocked exits - by furniture, bags, stages, bicycles, etc.? * Yes No A minimum of 36” clearance is provided in all hallways and exitways? * Yes No Is there storage in exits, aisles or under stairs, or on fire escapes? * Yes No Are there locks on the exterior doors that require keys or special knowledge to operate? * Yes No All EMERGENCY Lighting operates when the test button is pushed? * Yes No All EXIT signage lighting operates when the test button is pushed? * Yes No Has the Kitchen Hood Fire Suppression System been inspected with-in the last 6 calendar months? * Yes No Is the Fire Department Connection on street side of building and unobstructed view from the street? * Yes No Is the Fire Department Connection/Alarm Signage in place? * Yes No Do you have records of when the kitchen hood system was last cleaned? * Yes No Do you have records of the last boiler inspection and have the certificate posted? * Yes No Are your address numbers visible on the front of the house? * Yes No Are fire rated doors being propped open and do doors close automatically with activation of the fire alarm? * Yes No Are there any manually operated bolt locks/slide locks? * Yes No Has your wood burning fireplace been inspected this year by a chimney sweep? * Yes No Does your house have a SUPRA key box installed on the exterior with current keys? * Yes No Are storage areas generally neat and navigable? * Yes No Have all fire extinguishers had annual service within the last 12 months and are charged and have the appropriate labels affixed to the extinguisher? * Yes No Are the fire extinguishers mounted properly to the wall? * Yes No Is the clearance around electrical panels a minimum of 30" in front of and around the panel box? * Yes No Are there any broken/ missing/ ajar ceiling tiles? * Yes No Is there a minimum of 36” clearance around gas fired appliances like water heaters, furnaces, stoves? * Yes No Is there at least 18” clearance between all sprinkler heads and any storage? * Yes No Are there any extension cords in use? * Yes No Are there any open electrical junction boxes, light switches, or outlet boxes? * Yes No Are there any electrical faceplates/covers missing? * Yes No Are there any holes in the walls or ceilings (big or small)? * Yes No Is there an accumulation of trash and debris in or around your house? * Yes No Are there any compressed gas cylinders (CO2) which are not secured to the wall or racks? * Yes No Submit
