QUARTERLY BUILDING REPORT
Fire Safety Self -Inspection Checklist
Use the Checklist to conduct your own fire inspections in-between your annual Fire inspections.
1. If your answer is “Not Ok” Please file a work with Physical Plant at email@example.com and specify the “location” where the correction is
2. Complete and return this form to the Office of Risk Management.
Fire Protection Equipment
Fire extinguishers are fully charged and tagged.
*(it is charged if the yellow arrow in the pressure gauge is in the green area)
Fire extinguishers are accessible
Cabinet door is operable; extinguisher mounted at least 4” off
floor to not more than 5 feet top of extinguisher.
Fire extinguishers tags are current (serviced with last 12 months)
*(the tag expires one year from date of inspection)
Fire Sprinklers/detectors are free from obstruction
Sprinkler Heads: Storage is maintained 18”below
Sprinklers in need of replacement (damaged, corroded, painted)
Fire Hoses (@ Sierra Towers)—
When standpipe stations are enclosed in locked cabinets, and
doors are equipped with approved visual identification clear glass
panels, are glass panes easily broken?
Is the door capable of being opened when the glass panel is
broken? Is the unlocking handle painted red?
Is the direction the handled must be pushed or pulled indicated
to open the door? Is the door labeled Fire equipment-in case of
fire, break glass and operate red handle?
Is the hose system inspected at least annually and after each
use to assure that all the equipment and hoses are in place,
available for use, and in serviceable condition? [29 CFR
Is hemp or linen hose on existing systems un-racked,
physically inspected for deterioration, and re-racked using a
different fold pattern at least annually?
[29 CFR 1910.158(e)(2)(v)]
Fall ______ Building: ________________ Phone:_______________________
Spring ______ Safety Coordinator: ___________________ Date: _____________
Created by the Office of Risk Management & ADA
G:\My Documents\Safety\Inspection Forms\Quarterly Building Inspection Report.doc
Revised November 2011