Use on building or facility walk-through.

General Conditions

Yes No N/A
  1. Are walking surfaces clean, clear of debris, and dry?

  2. Are stairs, steps, handrails, and landings in good condition?
  3. Is area lighting adequate?
  4. Is general housekeeping acceptable and storage neat and orderly?
  5. Is furniture in a good state of repair?

Building Evacuation and Life Safety

  1. Are exits properly identified and lighted?
  2. Are exit paths clear?
  3. Are exit doors operable and equipped with panic hardware?
  4. Is emergency lighting operable?
  5. Does the fire alarm work?
  6. Has the fire alarm been tested?
  7. Are evacuation floor plans posted?
  8. Are emergency phone numbers posted in conspicuous areas throughout the building?
  9. Are "Do Not Use Elevator in Fire Emergency" signs posted and legible?

Fire Prevention

  1. Are portable fire extinguishers available?
  2. Are extinguishers serviced/tagged annually?
  3. Is the sprinkler system operable and tested regularly?
  4. When was the sprinkler system last tested? (Dam & PSI)
  5. Do smoke, heat & other detection alarm systems work? Date last tested?
  6. Is the ?No Smoking? policy enforced?
  7. Are fire doors self-closing? Date last tested?
  8. Are combustibles and trash controlled?
  9. Are flammables properly stored in cabinets?
  10. Is there any evidence of electrical equipment overheating?
  11. Is there a smoke/heat detector located near the furnace room?
  12. Are chimneys and flues inspected regularly? Date last inspected?
  13. Is lightning protection installed on towers, steeples, or spires?
  14. Are holiday decorations noncombustible and Underwriters Laboratories listed (UL-listed)?
  15. Has a licensed electrician inspected electrical wiring? Date inspected?
  16. Does wiring meet code requirements?
  17. Is there any evidence of electrical wiring overheating, blown fuses, tripped circuit breakers or worn insulation?
  18. Are multiple plug outlets and use of extension cords kept to a minimum?
  19. Are portable heating devices UL-listed?

Kitchen Fire Prevention

  1. Is the cooking ventilation system equipped with grease filters or extractors?
  2. Are cooking filters clean with no grease build-up?
  3. Does a dry chemical fire suppression system protect ductwork, cooking surfaces, and each deep fat fryer?
  4. Are dry chemical fire suppression systems serviced semi-annually by a licensed contractor and tagged accordingly? Date last serviced?
  5. Is the dry chemical fire suppression system linked to a shut-off valve to the fuel supply?
  6. Are deep fat fryers equipped with thermostats and high limit temperature control (475º F)?
  7. Is there a 10-pound dry chemical fire extinguisher (bicarbonate-based) in the immediate cooking area?

Boilers and Heating Equipment

  1. Are boilers and water heaters serviced regularly?
  2. Are state inspection certificates on file and current?
  3. Is any water/steam/fuel leakage noted?
  4. Is there a preventive maintenance service contract in effect on heating/air conditioning equipment?


  1. Are inspection certificates posted?
  2. Is there a preventive maintenance/service contract in effect?

Outside Grounds

  1. Is the parking area well maintained?
  2. Are exterior walkways in good physical condition?
  3. Is exterior illumination adequate?
  4. Are all lights functional?
  5. Is signage adequate and properly secured?
  6. Are walkways, roads, and parking lots kept clear of ice and snow?

Site-Specific Concerns

  1. Is playground equipment and surface material in good condition and inspected regularly?
  2. Are swimming facilities maintained in accordance with local and state safety regulations?
  3. Are camping facilities operated in accordance with local, state and federal safety regulations?
  4. Other concerns? (Address as necessary)