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