Fire Safety Inspection Form

Fire Safety Inspection Form

WHEREAS - Introduction

WHEREAS the Owner/Responsible Party engages the Inspector to perform a fire safety inspection of the premises identified below; and

WHEREAS the Inspector represents that the inspection will be conducted by qualified personnel in accordance with applicable industry fire safety standards and reasonable inspection practices; and

WHEREAS the parties agree that the results of this inspection, including findings and recommended corrective actions, will be recorded in this form and acknowledged by the parties below.

Parties & Facility Information

Facility Contact:    Phone:

Inspection Details

Inspection Date: Day   Month   Year    Time:

Inspector Information

License / Cert. No.:    Phone:

Scope of Work

The Inspector shall inspect the fire protection and life safety systems and conditions described below and report observed deficiencies and recommendations. The inspection does not include destructive testing unless expressly authorized in writing.

Inspection Checklist

Fire Alarm & Detection

System Present:    Operational / Tested:    Issues Noted:

Automatic Sprinkler System

System Present:    Valves Accessible:    Last Test Date (if known):

Portable Fire Extinguishers

Extinguishers Present & Accessible:    Inspection Tag Current:    Recharge/Replace Required:

Emergency Exits & Egress

Exit Signs Illuminated:    Exit Routes Unobstructed:    Emergency Lighting Operational:

Fire Doors & Compartmentation

Fire Doors Close / Latch Properly:    Penetrations Sealed:    Door Hardware Intact:

Housekeeping & Storage

Combustible Storage Clear of Exits / Equipment:    Hazardous Materials Labeled / Stored Properly:

Deficiencies / Observations

Provide clear, itemized descriptions of deficiencies, including location, code reference (if known), and recommended corrective action. Include required completion timeframe if specified by authority having jurisdiction.

Recommended Corrective Actions & Follow-up

Follow-up Inspection Required:    Follow-up Due Date: Day   Month   Year

Compliance Determination

Compliance Status:   Compliant    Non‑Compliant    Conditional / Limited Compliance

Payment Terms (If inspection is billable)

Inspection Fee Amount:

Late Fee / Interest on Overdue Amounts:

Term and Termination

Effective Date: Day   Month   Year

Termination Date (if applicable): Day   Month   Year

Termination Notice Period (days):

Confidentiality

All inspection records, reports, photographs, and related correspondence produced by the Inspector in connection with this inspection are confidential and intended for use by the Owner and designated parties. The Inspector will not disclose confidential findings to third parties except as required by law or with prior written consent of the Owner.

Limitation of Liability & Certification

The Inspector's inspection is a visual, non‑intrusive assessment unless otherwise agreed. The Inspector does not guarantee or warrant future conditions or the absolute compliance of the premises. To the maximum extent permitted by law, the Inspector's liability for any claim arising from this inspection is limited to the fee paid for the inspection. The Inspector certifies that, to the best of their knowledge, the statements and answers recorded on this form accurately reflect observations made during the inspection.

Governing Law; Entire Agreement

This form and any agreement between the parties arising from it shall be governed by the laws of the state or jurisdiction where the inspected property is located. This document constitutes the entire agreement between the parties with respect to the inspection and supersedes all prior understandings, whether written or oral, concerning the subject matter herein.

Acknowledgment

By signing below, the Inspector certifies the inspection was performed as indicated and the Owner acknowledges receipt of this inspection report and any recommendations contained herein.

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