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PRESCOTT FIRE DEPARTMENT (City of Prescott)

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PRESCOTT FIRE DEPARTMENT
Dear Business Owner / Manager:
The Prescott Fire Department has reinstated its Business Self-Inspection program. The program
is free of charge and is designed for the general business that has a low-hazard potential for fire
and life safety concerns. The primary occupancies targeted for this program are office buildings,
barber shops, etc.
The self-inspection program will allow these low-hazard businesses to be inspected by you, the
owner or manager, on a 24-month inspection cycle. We hope that by allowing you to identify
and eliminate common fire hazards, we will encourage you to continue to maintain a fire-safe
environment for your business without a visit from the Fire Department every two years.
In order to make our self-inspection program successful; we want to make it as user friendly as
possible. By following the simple instructions you will be able to conduct a fire safety
inspection of your building at your convenience. As always, if you have any questions or need
help with your self-inspection, the Fire Department is available to answer questions. You may
reach a Fire Inspector at (928) 777-1760. If needed, we will be happy to come to your business
and assist you.
With your support and cooperation, we can make the City of Prescott a safer community for all
of us, with less interruption and inconvenience for everyone.
Sincerely,
Eric Kriwer
Fire Marshal
Prescott Fire Department
1700 Iron Springs Rd. Prescott, AZ 86305
Phone: (928) 777-1700 Fax: (928) 776-1890 TDD: 445-6811
Self-Fire Inspection Form
Instructions: Fill in all the information on the form. Walk through your occupancy to ensure
the safety requirements on the checklist are fulfilled. If an item is compliant, check the “Yes”
box. If an item is non-compliant, either remedy the problem before submitting this form or
check the “No” box and we will follow up in ensuring the hazard is corrected. If an item does
not apply, check the “N/A” box. Any hazard not addressed in the questions can be typed into the
“Additional Comments” box.
The list is intended to cover the most common items / hazards we encounter while performing
fire inspections in low hazard occupancies. It is not intended to be all comprehensive or replace
specific code requirements not addressed on the form. If you have specific code related question
not addressed on this form, please call the City of Prescott Fire Department Prevention Division
at 928-777-1760.
Prescott Fire Department
1700 Iron Springs Rd. Prescott, AZ 86305
Phone: (928) 777-1700 Fax: (928) 776-1890 TDD: 445-6811
Self-Fire Inspection Form
Business Information
Occupancy Name (Business Name):
Street Number: Street Name: Apt./Room/Suite:
Business Mailing Address:
City: State: Zip Code:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Name of Person Performing Inspection, Last: First:
Email Address:
Emergency Contact Names & Phone Numbers (After-hours Responsible Parties to be contacted by Dispatch if necessary)
Emergency Contact #1 Name, Last: First:
Select all the options that apply:
Business Owner Property Owner Contact
Manager Responsible Party Resident/Occupant
Mailing Address: City: State: Zip Code:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Email Address:
Is Emergency Contact #1 a key holder?
Yes No
Emergency Contact #2 Name, Last: First:
Select all the options that apply:
Business Owner Property Owner Contact
Manager Responsible Party Resident/Occupant
Mailing Address: City: State: Zip Code:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Phone Number: ( ) - Phone Number Type:
Email Address:
Is Emergency Contact #2 a key holder?
Yes No
Page 1 of 2
Version 01/21/2011 14:40:40
BUSINESS
CELL
Provide atleast one phone number
FAX
CELL
HOME
Provide atleast one phone number
PAGER
WORK
CELL
HOME
PAGER
Provide atleast one phone number
WORK
Self-Fire Inspection Form
Yes No N/A
Building Exterior
Address numbers are visible & easy to read from your fronting street (contrasting colors)
All sides of the building are free from weeds, trash debris, or combustible storage.
Building Interior
EXIT PATHS are from any point in the building to the public way (exterior of the building).
Exits are clearly identified & exit signs are in the proper locations
The entire width & height of all exit paths is free from any obstruction (see definition above).
All exit doors open easily without special knowledge of the latching devices that may interfere with someone
getting out.
If exit signs are lighted, all of the bulbs are working.
Rooms, Spaces, & Walls
All breaches, missing ceiling tile / holes in the walls or ceiling that could allow fire into the hidden spaces
have been repaired or replaced.
No new walls have been added, without the necessary permits.
Electrical
There is a 30” clear area all around your electrical panel(s) so they are easily accessible, with door kept
closed.
All circuit breakers are labeled, in English, to show what they control.
All electrical outlets, switches & junction boxes have cover plates.
Extension cords are for temporary use only. (Used for 90 days or less, then removed.)
Extension cords are replaced with power strips with overcurrent protection & do not pass under rugs, through
walls or across traffic paths. All parts of any cord must be visible so that wear or bad spots can be noticed.
Storage / Housekeeping
All storage / housekeeping is neat & orderly.
There is no storage in equipment rooms, mechanical rooms, & electrical rooms or under open stairways.
Storage is piled no higher than 2 feet below the ceiling & never more than 12 feet high or no higher than 18
inches below the ceiling in buildings with sprinkler systems.
There are no flammable liquids stored, except in approved cabinets.
No more than 10 gallons of flammable liquid is stored in approved safety cans.
All combustibles are stored at least 3 ft. away from any heat sources including gas appliances, space heaters,
etc.)
All ven
ts of heat-producing appliances (heaters, water heaters, clothes dryers, etc.) are in good repair &
functioning properly.
Fire Extinguishers
Is there access to fire extinguisher(s)?
Are all fire extinguishers visible & accessible (not blocked)?
Have the fire extinguisher(s) been serviced & tagged by a fire extinguisher company within the last 12
months?
Fire extinguisher service company: Date of service:
Fire Protection System
Does the building or suite have a fire sprinkler system?
Does the building or suite have a fire alarm system?
Additional Comments:
I certify that I have conducted the self inspection of this business & have answered the above questions truthfully to the best of my knowledge.
Form completed by: Date & Time: .
Page 2 of 2
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PRESCOTT FIRE DEPARTMENT (City of Prescott)

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Completed 24 February 2021

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