INSTRUCTIONS: Each of the ABC Company fire inspection teams has been assigned a specific area of the facility to inspect. A team leader has also been designated to serve as the head of each team. That team leader will notify each member of the team of his or her duties including which area to inspect.

Each team member must complete this Questionnaire in conducting the inspection of the area to which he or she has been assigned. After completing the inspection, the team member will ensure that the Questionnaire has been thoroughly filled out and give it to his or her team leader. The team leader will review completed Questionnaires and sign them upon verifying their completeness and accuracy. The team leader will give all signed Questionnaires to the ABC Company Safety Director for evaluation and follow-up.

INSPECTION INFORMATION

Inspection Date: _______________________
Team Leader: _______________________
Inspecting Team Member: _______________________
Area/Department Inspected: _______________________
Team Leader Signature: _______________________

1. Are all exit doors in the area clearly marked?
YES      NO
If no, explain:
_____________________________________________________________________
_____________________________________________________________________

2. Are all exits and exit routes unobstructed?
YES      NO
If no, explain:
_____________________________________________________________________
_____________________________________________________________________

3. Are there any doorways that could be mistaken for exits
YES      NO
If yes, are they clearly identified as non-exits?YES      NO
If no, explain:
_____________________________________________________________________
_____________________________________________________________________

4. Do employees know where in the area portable fire extinguishers are located? (Ask at least five employees and select them randomly)
YES      NO
List employees asked:
_____________________________________________________________________
_____________________________________________________________________

5. Are employees in the area trained to use portable fire extinguishers? (Ask at least five employees and select them randomly)
YES      NO
List employees asked:
_____________________________________________________________________
_____________________________________________________________________

6. Can employees in the area who purport to have training explain in their own words how to use portable fire extinguishers? (Ask at least five employees and select them randomly)
YES      NO
List employees asked:
_____________________________________________________________________
_____________________________________________________________________

7. Have any portable fire extinguishers been removed from the area?
YES      NO
If yes, has equivalent protection been provided?
YES      NO
Explain:
_____________________________________________________________________
_____________________________________________________________________

8. Are there any signs of corrosion or mechanical damage to any of the portable fire extinguishers?
YES      NO
If yes, describe, including extinguisher(s) location(s):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

9. What is the last inspection date shown on each fire extinguisher (list each one separately)
_____________________________________________________________________

10. Are there any combustible materials, scraps or debris in the area?
YES      NO
If yes, have employees been instructed to store and/or remove such items in a safe manner? YES      NO

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