self inspection
Business Name
Business Address Suite/Bldg Phone
Mailing Address
Emergency Contact Name Phone

  Yes No N/A
Is the building address number posted with a contrasting background, and clearly visible from the street?
Is the exterior of the building free from weeds, debris or combustible storage?
Are all required exit paths, including aisles, hallways, stairways and walkways clear of obstructions?
Are all exit doors unlocked, marked with exit signs, and can be opened easily from the inside?
Are all required exit signs and emergency lighting in operable condition?
Are walls intact without holes or open penetrations and all ceiling tiles in place?
Is there 36" of clear space maintained in front of electrical panel?
Are circuit breakers properly marked?
Are cover plates in place for switches, receptacles, and junction boxes?
Are extension cords being used as a substitute for permanent wiring?
Are mechanical rooms, electrical rooms, and areas under stairways clear of combustible storage?
Is there a 24" clearance between storage and ceiling (non-sprinklered building), or 18" clearance between storage and sprinkler head (sprinklered building)?
Are combustibles stored at least three feet away from heat sources?
Do fire extinguishers have a minimum rating of 2A/10BC?
Are fire extinguisher locations visible and unobstructed?
Have fire extinguishers been serviced and tagged by a licensed company within the past 12 months?
Does your building have a sprinkler system?
Does your building have a fire alarm system?
Have these systems been inspected by a qualified fire protection contractor in the past 12 months?
Name of Person Completing Form: Date

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