Business Self-Inspection Form

Please review the following self-inspection statements. Complete this form by indicating 'Yes', 'No', or 'N/A' if it does not apply, to each statement. Once all of the questions have been answered, please enter your full name. Most all of the questions require an answer. Once complete, click "Submit" to send the form to Salt River Fire Department. Thank you in advance.

Business Information

Business Name

Business Street Address

Business Zipcode

Mailing Address (if different from business address)

Mailing Zipcode

Business Phone

Emergency Contact Name (for after-hours notifications)

Emergency Contact Phone

Building Exterior

Is the building address number posted with a contrasting background and clearly visible from the street?
YesNoN/A

Is the exterior of the building free from weeds, trash, debris or combustible storage?
YesNoN/A

Building Interior

Are exit aisles and corridors a minimum of 36 inches wide and clear of obstructions?
YesNoN/A

Are all exit doors unlocked, marked with exit signs and can be easily opened easily from the inside?
YesNoN/A

If emergency lighting is provided does it operate properly?
YesNoN/A

Are walls intact without holes or open penetrations? Are ceiling tiles in place?
YesNoN/A

Electrical

Is a 30-inch wide and 36-inch deep unobstructed access space maintained in front of electrical panel?
YesNoN/A

Are circuit breakers properly marked?
YesNoN/A

Are unused circuit breaker spaces properly covered with blanks?
YesNoN/A

Are cover plates in place for switches, receptacles and junction boxes?
YesNoN/A

Are extension cords being used as permanent wiring?
YesNoN/A

Storage

Are mechanical rooms, electrical rooms and areas under stairways clear of combustible storage?
YesNoN/A

Is there a 24-inch clearance between storage and ceiling (non-sprinklered), or 18-inch clearance between storage and sprinkler head (sprinklered)?
YesNoN/A

Are combustibles stored at least three feet away from heat sources?
YesNoN/A

Fire Extinguishers

Do fire extinguishers have a minimum rating of 2A/10BC?
YesNoN/A

Are fire extinguisher locations visible and unobstructed?
YesNoN/A

Have fire extinguishers been serviced and tagged by a qualified contractor within the past 12 months?
YesNoN/A

Fire Extinguishers

Does your occupancy have a sprinkler system?
YesNoN/A

Does your occupancy have a fire alarm system?
YesNoN/A

If you have one or both of the above have they been serviced by a qualified fire protection contractor in the past 12 months?
YesNoN/A

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