Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Fire Department Self Inspection Form

  1. 2019 Door logo
  2. Occupancy Emergency Contact Names & Phone Numbers
  3. Access and Premises
  4. Are the exitways and doors easily recognizable, unobstructed and maintained functional? *
  5. Is there maintained a minimum 3' clearance around fire hydrants?
  6. Are address numbers for the building clearly visible from the street?
  7. Is combustible vegetation removed so as to not create a fire hazard?
  8. Egress Requirements
  9. Are doors with self-closing hinges maintained in the closed position (not blocked open)?*
  10. Are the exitways and doors easily recognizable, unobstructed, and maintained functional? *
  11. If the main exit door is provided with key-locking hardware as allowed by code, is there a sign above the door that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED" and are the other exit doors openable from the inside without the use of a key or any special knowledge or effort?
  12. Are the other required exit doors readily openable from the inside without the use of a key or special knowledge or effort?*
  13. Are the exits and exit enclosures free from the storage of combustible materials*
  14. Is the means of egress illuminated when the building or structure is occupied? *
  15. In residential occupancies, are emergency escape or rescue windows, doors or window wells required by the Building Code for sleeping rooms maintained openable and free from any obstruction that would inhibit the occupant from escaping?*
  16. Electrical
  17. Are all electrical outlets, switches and junction boxes properly covered with cover plates and is the electrical system safe from any apparent shock and/or other electrical hazards?
  18. Are circuit breakers/fuses labeled so as to identify the area protected?*
  19. Is the area maintained clear at least 30" in front of electrical panel(s)?*
  20. Are extension cord(s) maintained in good condition, and only used as temporary wiring, or to service small portable appliances?*
  21. Are extension cord(s) grounded when serving grounded appliances?*
  22. Are extension cords used only for temporary use (up to 90 days)?*
  23. If multiple items need to be plugged in, is a power tap utilized with a built-in circuit breaker and is the power tap plugged directly into a permanently installed receptacle?
  24. Emergency Lighting/Egress Illumination
  25. If emergency lighting is provided, is it maintained in operable condition?
  26. Exit Signs
  27. If exit signs are required, are they maintained illuminated or self-luminous?*
  28. Does the backup-battery work (push the test button and the exit sign should illuminate under battery power)?*
  29. Fire Alarm System
  30. If the building is equipped with a fire alarm system, has the required annual service of the fire alarm system been performed by a qualified fire alarm company?*
  31. Fire Extinguishers
  32. Fire Extinguishers View Informational Slides
  33. Have the fire extinguisher(s) been serviced and tagged by a fire extinguisher company within the last 12 months?
  34. Is the travel distance from all portions of the building less than 75’ to a fire extinguisher?
  35. Are all fire extinguishers visible and accessible (not blocked)?
  36. Are the fire extinguisher(s) properly mounted? (Proper locations-near exit doors where possible, not exceeding maximum travel distance, properly mounted (maximum 5’ high if <40 lbs., maximum 3 ½’ high if >40 lbs. In all cases, minimum 4” above the ground).
  37. Fire Safety & Evacuation Plans
  38. * If required, are Evacuation Plans posted?
  39. If required, do you have Fire Safety Plans?*
  40. If fire drills are required, are they conducted successfully at varying times and under varying conditions and are records maintained on the premises?
  41. Fire/Smoke Separations
  42. Are the fire/smoke separations (automatic smoke doors, fire doors, etc.) maintained and in working condition?
  43. Fire Suppression Systems
  44. If the building is equipped with a fire sprinkler system, has the required annual service of the fire sprinkler system been performed in the last year by a qualified sprinkler company?
  45. Is the top of storage maintained a minimum 18” below head deflectors in fire sprinklered areas
  46. In commercial cooking applications, has the hood suppression system been serviced in the last six months and is the hood cleaned at intervals to prevent the accumulation of grease?
  47. Heat Producing Appliances
  48. If portable electric heaters are used, are they used safely? Also, are they plugged directly into wall outlets and kept a minimum of 3' away from combustibles?
  49. Is the clearance between ignition sources, such as light fixtures, heaters, and flame producing devices, and combustible storage maintained in an approved manner?
  50. Housekeeping & Decorations
  51. Are oily rags or similar materials stored in metal, metal-lined or other approved containers equipped with tight-fitting covers? *
  52. Mechanical Hazards
  53. Are safe clearances maintained between gas fired appliances (such as water heaters, furnaces, etc.) and combustible materials?*
  54. Storage of Combustibles
  55. Is the storage of combustible materials orderly?
  56. Are combustible materials not stored beneath the building or structure?
  57. Are the boiler rooms, mechanical rooms and electrical panel rooms maintained without the storage of any combustible materials within?
  58. Are dumpsters that are 1.5 cubic yards or more not stored inside the building and placed more than 5’ from combustible walls, openings or combustible roof eave lines?
  59. Storage, Compressed Gas Cylinders
  60. If you have compressed gas containers (such as co2, helium, etc.), are they chained to prevent falling?
  61. Storage of Flammable and Combustible Liquids
  62. Are quantities in excess of 10 gallons of flammable and combustible liquids used for maintenance purposes and the operation of equipment stored in liquid storage cabinets?
  63. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  64. Leave This Blank:

  65. This field is not part of the form submission.