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Self-Inspection Form
Self-Inspection Form
Self-Inspection Form
First Name
Last Name
Email
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
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