Enter building name and month and year for date of inspection, place a check in the box to verify inspection statement; enter remedial action as needed.
Exits Lights - Exits lights are checked to verify they are lit
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Date of Inspection (MM/YY) |
Verify Inspection Statement |
Remedial Action |
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Emergency Lights - Emergency lights are tested to verify they will turn on without electricity
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Date of Inspection (MM/YY) |
Verify Inspection Statement |
Remedial Action |
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Fire Extinguishers - Fire extinguisher inspection is verifying the hose is in good condition, the pin is in place, Annual Inspection Tag is current, proper mounting, sign in place, unobstructed access and pressure is in the green area. Enter OK and sign monthly inspection tag.
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Date of Inspection (MM/YY) |
Verify Inspection Statement |
Remedial Action |
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All electrical panels are unobstructed with a 30" clearance, closed and latched, have switches labeled.
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Date of Inspection (MM/YY) |
Verify Inspection Statement |
Remedial Action |
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Doors and stairs
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Remedial Action |
| All exit doors are unobstructed |
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| All stairways are unobstructed |
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| All fire doors are unobstructed, not chocked open and are working properly |
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Inspector's signature: ______________________________________
