Business Self Inspection Form

Please fill out the Self Inspection form on a PC as it will not allow uploads from a mobile device.
Fields marked with (*) are required.
Fields marked with (U) have the ability to attach a picture at the bottom of the form.

Inspection Type(*)

Initial InspectionRe-inspectionComplaint inspection

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PROPERTY INFORMATION

Business Name(*)

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Address:(*)

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Suite Number (if applicable):

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Phone Number:(*)

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CONTACT INFORMATION

Contact Person:(*)

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Title:(*)

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Phone Number:(*)

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Cell Number:

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E-mail Address:(*)

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Emergency Contact (if different from Contact Person)

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Emergency Contact Phone Number:

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Owner Name:

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Address:

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Phone Number:

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Cell Number:

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E-mail Address:

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INSPECTION CATEGORIES

BUILDING SERVICES

Portable unvented heaters used properly. Portable, electric space heaters shall not be operated within 3 feet (914 mm) of any combustible materials. (*)

YesNoNA

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Emergency lighting tested once a month and documented (U)(*)

YesNoNA

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Clearance between sprinkler head/storage and ceiling maintained. Storage shall be maintained 2 feet (610 mm) or more below the ceiling in nonsprinklered areas of buildings or not less than 18 inches (457 mm) below sprinkler head deflectors in sprinklered areas of buildings. (*)

YesNoNA

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Combustible material not stored in emergency exits (*)

YesNoNA

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No combustible storage in mechanical/electrical/boiler rooms (*)

YesNoNA

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No storage under unsprinklered overhangs of sprinklered buildings. (*)

YesNoNA

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EMERGENCY PLANNING AND PREPAREDNESS

Fire safety, evacuation and/or lockdown plans completed and approved (*)

YesNoNA

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Required fire drills are completed (*)

YesNoNA

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Hazard communication plans prepared / Safety Data Sheets are accessible (*)

YesNoNA

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FIRE PROTECTION

Fire rated assemblies maintained (penetrations in fire walls repaired)(*)

YesNoNA

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Fire protection systems inspected (hood, fire alarm, sprinkler) (U)(*)

YesNoNA

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All fire doors have been inspected annually (this is a new requirement in the fire codes requiring all fire doors to be inspected on an annual basis) (U)(*)

YesNoNA

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Fire protection maintenance records maintained on site (*)

YesNoNA

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Fire extinguishers properly installed and maintained (U)(*)

YesNoNA

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FDC requirements met (it is readily accessible, marked, protective caps in place) (*)

YesNoNA

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FIRE SERVICE FEATURES

Address/suite number property identified and visible (*)

YesNoNA

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Security gates compliant (*)

YesNoNA

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Exterior doors and openings maintained (*)

YesNoNA

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Fire lane clear and unobstructed and properly labeled (*)

YesNoNA

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Knox box is installed (required if you have an automatic fire suppression or fire alarm system)(*)

YesNoNA

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Please take photo(s) of all breaker panel(s) opened (U)(*)

YesNoNA

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Electrical panel is clear and accessible.(U)(*)

YesNoNA

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Mutiplug adapters/extension cords are not being used(*)

YesNoNA

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Elevator emergency signs installed (In Fire Emergency, Do Not Use Elevator. Use Exit Stairs) (*)

YesNoNA

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All cooking operations are under a Type I ventilation hood (*)

YesNoNA

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Commercial cooking hoods inspected, cleaned and tagged by qualified individuals (U)(*)

YesNoNA

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All cooking oil stored in proper containers (*)

YesNoNA

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MEAN OF EGRESS

Exits are free from obstructions that would prevent its use(*)

YesNoNA

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All labeled emergency exits can open with a single action.(*)

YesNoNA

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Exit doors are free from unapproved security devices.(*)

YesNoNA

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All exit signs are visible and illuminated (*)

YesNoNA

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All emergency exits are clearly visible (*)

YesNoNA

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Occupant load is posted in Assembly occupancies (U)(*)

YesNoNA

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Stairs and elevated areas over 30” have proper railings/handrails (*)

YesNoNA

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All aisles are minimum of 36" clear width (*)

YesNoNA

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GENERAL FIRE PROTECTION

Combustible waste material properly stored (trash is not accumulated, weeds and grass not creating a fire hazard. (*)

YesNoNA

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Clearance between ignition sources (luminaires, heaters, flame-producing devices, heating appliances) and combustible materials shall be maintained in an approved manner.(*)

YesNoNA

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Fueled equipment stored properly (i.e. lawn mowers, blowers, etc.)(*)

YesNoNA

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Elevator Knox box installed (*)

YesNoNA

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Correct keys inside of the required Knox box(es) – this can be scheduled with your inspector to verify (*)

YesNoNA

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Clear space is maintained around fire hydrants (a minimum of 3 feet is required) (*)

YesNoNA

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Fire protection equipment properly identified (including rooms or spaces) (*)

YesNoNA

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Suite utilities properly identified (both gas and/or electric) (*)

YesNoNA

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Rear doors identified with suite numbers (*)

YesNoNA

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Fire protection equipment accessible (U)(*)

YesNoNA

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Any comments concerning inspection

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Submit Form To:(*)

Fire Marshal Dan Wiltse

Scott Cochran

Sandy Stroud

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Upload Images

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