C:\Users\czaino\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\TPZS3A6N\REPORT OF KITCHEN AUTOMATIC FIRE EXTINGUISHING SYS INSP NEW
Attachment 1.doc 16Jul10
LEAVE NO QUESTION UNANSWERED
COMMENTS:_____________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
HAS ANY EQUIPMENT BEEN ADDED SINCE LAST INSPECTION? YES NO UNK
IS EXTINGUISHING SYSTEM UL 300 COMPLIANT? YES NO
SYSTEM IS ARMED AND OPERATIONAL: YES NO
SIGNED:_______________________________ _______________________________
TECHNICIAN NAME NOT COMPANY NAME OWNER OR AGENT
RETURN TO THE SAG HARBOR CODE ENFORCEMENT OFFICER
PO BOX 660, SAG HARBOR, N.Y. 11963
TEL:
631-725-2804 FAX: 631-725-4852
IS THERE A FIRE ALARM SYSTEM
PRESENT?
YES NO UNK
HOOD CLEANING STICKER IS AFFIXED YES NO
IS THE EXTINGUISHING SYSTEM
MONITORED BY THE FIRE ALARM?
YES NO N/A UNK
DATE OF LAST HOOD CLEANING
DATE_________________________
ELECTRICITY IS REQUIRED FOR
EXTINGUISHING SYSTEM OPERATION
YES NO
GREASE ACCUMULATION HEAVY MODERATE LIGHT
SYSTEM HAS AUDIBLE OR VISUAL
ALERT AFTER DISCHARGE
YES NO
FILTERS ARE INTACT YES NO
FAN IS IN OPERATING ORDER YES NO UNK
LOCATED BETWEEN 42 IN. AND 60 IN.
ABOVE THE FLOOR
YES NO
LIGHTING IN HOOD IS PROPERLY
PROTECTED FROM DAMAGE
YES NO N/A UNK
ACCESSIBLE AND LOCATED IN A PATH
OF EGRESS
YES NO
CLEARLY IDENTIFIES THE HAZARD
PROTECTED
YES NO
CYLINDER MANUFACTURE DATE(S)
DATE:__________________________
FAILURE WILL IMPAIR AUTOMATIC
SYSTEM OPERATION
YES NO UNK
DATE OF LAST 6-YEAR MAINTENANCE N/A DATE:_____________
SEAL IS INTACT YES NO
DATE OF LAST HYDROSTATIC TEST N/A DATE:_____________
PERSONNEL INSTRUCTED IN THE USE
OF THE SYSTEM
YES NO
WEIGHT OF CARTRIDGE
(CARTRIDGE OPERATED UNITS)
N/A DATE:_____________
PRESSURE READING
PSI
VERIFIED TRAVEL OF CABLE AND LINK
POSITION
YES NO
EXTINGUISHING AGENT CYLINDER
WEIGHT(s)
__________________________
VERIFIED OPERATION OF GAS
SHUTOFF VALVE
YES NO
VERIFIED OPERATION OF MICRO-
SWITCH
YES NO N/A
CHECKED AND CLEANED FUSIBLE
LINKS
YES NO
MANUFACTURE DATE OF FUSIBLE
LINKS
DATE:____________________
REPLACED FUSIBLE LINKS YES NO
NOZZLES CLEANED YES NO
TYPE K PORTABLE FIRE
EXTINGUISHER PRESENT
YES NO
PROPER NOZZLE CAPS IN PLACE YES NO
EXTINGUISHER IS PLACARDED AS
BACKUP EXTINGUISHMENT MEANS
YES NO
GAS SHUTOFF VALVE CONTROLS ALL
EQUIPMENT PROTECTED BY SYSTEM
YES NO
PERSONNEL ARE INSTRUCTED IN THE
USE OF EXTINGUISHER
YES NO
