INDEX
Date: _______________________ Occupancy class: ______________________________________________
Address no. __________________ Street name: _________________________________________________
Suite or unit no.: ______________ Group insp. no.: __________________________________________
Fire code permits req.: YES ____ NO ____ Occupancy load: Day ____________ Night _____________
No. of units or suites: ___________ Priority: __________ Area of response: __________________
Last occ. insp.: _________ Stories: ______ Basement: Levels ______ Sq. ft. __________________
Emergency lighting: YES ___ NO ___ Lock box: YES ___NO ___ Fire lanes: YES ___ NO ___________
Guard dogs: YES ___ NO ___ No. with fireman feature: ____ Exit plans: YES ____ NO ___________
Exit drills: YES ____ NO ____ Standpipe system: Wet ____ Dry _____None ______________________
House lines: YES ___ NO ___ Fire pumps: YES ___ NO ___ Hood sys.: YES _____NO _______________
Automatic sprinkler system: Full __________ Part __________ None ____________________________
Unsupervised: ___ Supervisor name: _____________________________ || Phone: __________________
Fire alarm system: YES ____ NO ______________________________________________________________
Unsupervised: ___ Supervisor name: ______________________________ || Phone: _________________
Search warrant used: YES ______ NO ______ Pervious fire history: YES ______ NO ______________
Hazardous material: YES ________NO _________ Build placarded: YES ________ NO _______________
Explosives type: None ____ A ____ B ____ C ____ Explosives magazine: YES _____ NO ___________
Flammable liquid: AG gal. ________ UG gal. _______ LP gas: AG gal. _______ UG gal. __________
Responsible party name: _______________________________ Home phone: _________________________
Inspection hours: ___________________ Complete inspection date: _____________________________
Responsible party name: ______________________________ Home phone: __________________________
Build. draw required: YES ________ NO ________ Drawing completed: YES _____ NO ______________
PROPERTY MANAGEMENT
Occupancy name: ________________________________________________ Phone: _____________________
Business owners name: _____________________________________ Home phone: ____________________
Build/Property owners name: _________________________________ Home phone: ___________________
Responsible party: __________________________________________ Date of birth: ________________
Home address: ____________________________________________ Home phone: ______________________
State: ____ Drivers lic. no.: ___________________ Social security number: ___________________
THE FOLLOWING ITEMS ARE IN VIOLATION
Exit Requirements Hazardous materials Fire protection Building & Grounds
1. Number required 9. Storage handling use 17. Fire dept. connections 25. Dry vegetation
2. Door width/swing 10. Hazardous chemicals 18. Automatic sprinklers 26. Trash conditions
3. Locks, latches 11. Flamm./comb. liquids 19. Automatic exting. sys. 27. Fire lanes
4. Exit signs 12. LP gas 20. Portable extinguishers 28. Dangerous conditions
5. Power oper. doors 13. Explosives 21. Hydrants 29. Decorative materials
6. Obstructions/aisles 14. Haz. mat. application 22. Fire alarm system 30. Open flame devices
7. Travel dist. to exit 15. Fire diamond (NFPA) 23. Fire doors 31. Electrical
8. Emergency lighting 16. Fire code permits 24. Stand pipe 32. Other-Specify in remarks
REMARKS
Item Fire code Specific Correction Corrected Correction
no. section reference required by (date) verified by
(date) (Print name)
______/________/____________/_____________/_______________/__________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Item Fire code Specific Correction Corrected Correction
no. section reference required by (date) verified by
(date) (Print name)
______/________/____________/_____________/_______________/__________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
The items noted are in violation of the Fire Code. This is an official notice
of ordinance violation requiring correction within the specified time. Failure
to comply with these requirements may lead to legal action. Violation of the
Fire Code is a violation of City Ordinance G-xxx, as amended, a Class 1
misdemeanor punishable by a fine not to exceed Two Thousand Five Hundred Dollars
or imprisonment not exceeding six months or both. This inspection is intended
for your safety and the safety of the citizens of the City. Your cooperation is
greatly appreciated. For information concerning this inspection
call -- Phone: (xxx) xxx-xxxx
Company inspector: ______________________________________ Station no.: _____________
Referred to city prosecutor by: _______________________________ Date: _______________
Fire incident report number: ______________________________________________________
General Inspection Methodology & Procedures
FPT 102 - Fire Prevention and Inspection // Instructor: Kevin M. Kolb Slide #7