Life-Safety Inspection

Annual Fire Code Check

Building / address

Occupancy type

Inspector

Permit no.

Date

Result P Pass F Fail / Deficiency NA Not Applicable

Extinguishers

ItemResultDeficiency

Correct type & rating for hazard

Charged, sealed & annual tag current

Mounted, visible & unobstructed

Alarms & Detection

ItemResultDeficiency

Smoke & heat detectors functional

Pull stations accessible & marked

Audible/visual notification & panel clear

Sprinklers

ItemResultDeficiency

Control valves open & supervised

Heads unobstructed, 18" clearance

FDC caps, signage & gauges

Exits & Emergency Lighting

ItemResultDeficiency

Exit doors operable & unobstructed

Illuminated exit signs functional

Emergency lights pass 90-min test

Electrical & Storage

ItemResultDeficiency

Panel 36" clearance, no extension cords

Storage 24" below ceiling / sprinklers

Flammables stored in rated cabinet

Deficiencies & verdict

Deficiencies cited

Re-inspection due

Inspection result Passed — no deficiencies Corrections required

Inspector signature

Printed name

Cert. no.

Building representative

Printed name

Date received

This inspection reflects observed conditions on the date shown and does not relieve the owner of ongoing compliance with the adopted fire code. Cited deficiencies must be corrected before the re-inspection date; imminent-hazard items require immediate correction. The building representative acknowledges receipt of this report.