2. 
6. Contact Information
8. Business Name*
9. Business Phone #*
11. Primary Contact*
12. Primary Contact Phone #*
13. Email Address*
15. Address *
17. City*
18. State*
19. Zip Code*
21. Emergency Contact Information
23. Emergency Contact 1*
24. Emergency Contact 1 Phone #*
26. Emergency Contact 2*
27. Emergency Contact 2 Phone #*

31. Self Inspection Checklist

33. Access & Premises
35. Property address is marked in large numbers and is clearly visible from the street.

    1. Complete
    2. N/A
37. Fire lanes are properly marked and are unobstructed.

    1. Complete
    2. N/A
39. Areas outside and around the building free of weeds, debris and trash.

    1. Complete
    2. N/A
41. Fire Hydrants are clear of vegetation, debris, etc. for a minimum of 5 feet.

    1. Complete
    2. N/A
43. Egress (Exiting)
45. Exit signs are provided and are in working order if provided with illumination.

    1. Complete
    2. N/A
47. If the main exit door is provided with key-locking hardware, as allowed by code, the following signage must be posted on the door "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED" Secondary exits are operable from the inside without the use of a key or any special knowledge or effort

    1. Complete
    2. N/A
49. Exit(s) and exit pathway(s) are clear of obstructions.

    1. Complete
    2. N/A
51. Emergency lighting is maintained and in operable condition.

    1. Complete
    2. N/A
53. Electrical
55. All electrical outlets, switches and junction boxes are closed or covered.

    1. Complete
    2. N/A
57. Circuit breakers/fuses are labeled so as to identify the area protected.

    1. Complete
    2. N/A
59. Electrical panel(s) must remain clear of obstructions a minimum of 30 inches.

    1. Complete
    2. N/A
61. Extension cords are utilized for temporary use only.

    1. Complete
    2. N/A
63. All multiple Outlet Power strips are UL listed and equipped with a built-in circuit breaker, which is plugged directly into a permanently installed receptacle.

    1. Complete
    2. N/A
65. Fire Alarm/Fire Sprinkler System
67. The Fire Alarm / Fire Sprinkler system (s) have been inspected within the last 12 months..

    1. Complete
    2. N/A
69. Fire Extinguishers/Suppression Systems
71. The Commercial Cooking Fire Suppression System has been inspected within the last 6 months.

    1. Complete
    2. N/A
73. Fire extinguishers are clearly marked and accessible.

    1. Complete
    2. N/A
75. All extinguisher(s) have been serviced / tagged by a fire extinguisher company within the last twelve months.

    1. Complete
    2. N/A
77. Storage of Compressed Gas Cylinders
79. Compressed gas cylinders (Co2, helium, etc.) are properly secured.

    1. Complete
    2. N/A
81. Storage of Combustibles
83. Boiler rooms, mechanical rooms and electrical rooms are clear of any combustible materials.

    1. Complete
    2. N/A
85. Combustible materials are stored properly, away from any heat source.

    1. Complete
    2. N/A
87. Agreement
89. I have completed this form to the best of my knowledge.

    1. I agree
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91. 1. Receive an email copy of this form.
92. Email address

    This field is not part of the form submission.

93. Submit

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