Self Inspection

Business Name

Business Physical Address

Owner/Operator Contact Name

Owner/Operator Phone Number

After Hours Contact Name

Your Email

If you do not feel comfortable doing your inspection, please check "No" in the box to the right to request a standard inspection.YesNo

Building Exterior

Are address numbers clearly visible from the street?
YesNoN/A

Are all sides of the building free from weeds, trash, debris, or combustible storage?
YesNoN/A

Are all dumpsters and containers stored at least five (5) feet away from combustible walls, openings, and roof eaves?
YesNoN/A

Are all vents of heat producing appliances (furnace, hot water, dryer, etc.) in good repair and functioning properly?
YesNoN/A

Is there a minimum of three (3) feet clearance around fire hydrants?
YesNoN/A

If your business has a Knox Box are the keys up to date?
YesNoN/A

Building Interior

Have breaches, missing ceiling tiles, holes in the walls or ceiling been repaired?
YesNoN/a

Have any new walls been added that would interfere with exiting, fire alarm, or sprinkler coverage?
YesNoN/A

Do all natural gas appliances have individual shut offs?
YesNoN/A

Egress/Exiting

Are all exit doors free of locking bolts, bars, padlocks and capable of operation from the inside without the use of a key or special knowledge?
YesNoN/A

Are the exit ways and doors easily recognizable, unobstructed and maintained?
YesNoN/A

Do all exit door self-closure devices operate and the door fully close and latch when released?
YesNoN/A

Do doors open with relative ease?
YesNoN/A

Are all exit paths clear of obstructions, displays, and combustible materials? (Note: Exit paths are from any point in the building to the public way)
YesNoN/A

Emergency Lighting/Egress Illumination

If emergency lighting is present, is it maintained and operable?
YesNoN/A

Are all egress paths illuminated at all times when the building is occupied?
YesNoN/A

Exit Signs

If exit signs are present, are they illuminated at all times?
YesNoN/A

Does the exit sign battery backup work? (Push the test button, sign should light)
YesNoN/A

Electrical

Do all electrical switches, outlets and junction boxes have cover plates and not broken?
YesNoN/A

Is there a minimum of 36 inches clear space in front of electrical panels?
YesNoN/A

Are all circuit breakers labeled and the door closed?
YesNoN/A

Are open spaces in electrical panel properly covered?
YesNoN/A

Are extension cords used only for temporary use (less than 30 days)?
YesNoN/A

Do electrical cords pass under rugs, through walls, or across traffic paths? Cords must be visible at all times.
YesNoN/A

Are UL listed surge strips used in place of extension cords?
YesNoN/A

Are all appliances such as refrigerators, coffee pots, space heaters etc plugged directly into a wall outlet?
YesNoN/A

Do space heaters have tip over protection?
YesNoN/A

Housekeeping and Storage

Is storage of combustible materials neat and orderly and no higher the two (2) feet below the ceiling?
YesNoN/A

Are equipment rooms, mechanical rooms, electrical rooms and under stairways free of combustible storage?
YesNoN/A

Are all combustibles stored at least three (3) feet from heat producing appliances?
YesNoN/A

Are flammable liquids properly stored?
YesNoN/A

Are compressed cylinders properly stored and secured?
YesNoN/A

Fire Alarm Systems

If the building is equipped with a fire alarm, has the system been tested/serviced by a licensed contractor within the last 12 months?
YesNoN/A

Have batteries in smoke detectors been changed in the last six (6) months?
YesNoN/A

Fire Extinguishers

Is the travel distance to any fire extinguisher less than 75 feet?
YesNoN/A

Have the fire extinguishers been service and tagged by a licensed service company within the last twelve (12) months?
YesNoN/A

Are all fire extinguishers visible and unobstructed and mounted no higher than sixty (60) inches from the floor?
YesNoN/A

Are all fire extinguishers at least rated at 2A-10BC minimum size and type?
YesNoN/A

Fire Suppression Systems

If the building is equipped with a sprinkler system, has it been tested and serviced by a licensed contractor in the past twelve (12) months?
YesNoN/A

Is there a minimum of 18 inch clearance below the sprinkler head to top of storage?
YesNoN/A

If equipped with a Fire Department Connection on the exterior is it labeled and clear of obstructions?
YesNoN/A

For commercial cooking, has the hood system been serviced within the last six (6) months?
YesNoN/A

Note: You will be contacted by an NFD Inspector for all “No” responses to address violations. All violations must be corrected within 30 days of the completed inspection date. If violations are not remedied, you will be subject to a re-inspection by the Fire Department.

Upon completion of this form: Forms shall be completed within 30 business days from notification. Failure to return the form in the allotted time will subject you to a full inspection by the Fire Department.

1. No Misrepresentations, False Statements, Inaccurate Information.
You hereby represent to the Fire Department that you provided information for the completion of your business inspection without intentionally or negligently making false statements or misrepresentations of any kind during the course of the Inspection. Further, you agree to be responsible for any damages or claims made against the Fire Department that arise from or are caused by your providing false or inaccurate information or making misrepresentations during the course of your Inspection.

2. Indemnity.
You agree to indemnify and hold the Fire Department, its officers, employees and agents, harmless from any third-party claim or cause of action, including reasonable attorneys’ fees and costs, arising, directly or indirectly, out of your access to or use of Fire Department affiliated web sites, emails or inspection results in connection with your Inspection, the information contained therein, and results thereof, or your violation of any law or the rights of any person.

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