Please review the following self-inspection statements. If you would like you may print a hard copy from the website menu to fill out to assist you in submitting your inspection online. Complete this form by indicating a yes, no or N/A if it does not apply to each statement. Once all of the items have been corrected please print your full name and put your initials in the boxes below. Most all of the questions require an answer. Once complete hit submit and it will be e-mailed to the Flagstaff Fire Department Prevention Office. Thank you in advance.

Business Information

Business name?*

Business street address?*

Business zip code?*

86001 86002 86004 86005

What is your mailing address if different from the business address?

Mailing zip code?

86001 86002 86004 86005

Business phone?*

Emergency contact name for after hours notifications?*

Emergency contact phone number?*

Building Exterior

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

Yes No N/A

Is the exterior of the building free from weeds, trash, debris or combustible storage?*

Yes No N/A

Building Interior

Are exit aisles and corridors a minimum of 36 inches wide and clear of obstructions?*

Yes No N/A

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

Yes No N/A

If emergency lighting is provided does it operate properly*

Yes No N/A

Are walls intact without holes or open penetrations? Are ceiling tiles in place?*

Yes No N/A

Electrical

Is a 30" wide and 36" deep unobstructed access space maintained in front of electrical panel?*

Yes No N/A

Are circuit breaker properly marked?*

Yes No N/A

Are unused circuit breaker spaces properly covered with blanks?*

Yes No N/A

Are cover plates in place for switches, receptacles and junction boxes?*

Yes No N/A

Are extension cords being used as permanent wiring?*

Yes No N/A

Storage

Are mechanical rooms, electrical rooms and areas under stairways clear of combustible storage?*

Yes No N/A

Is there a 24" clearance between storage and ceiling (non-sprinklered), or 18" clearance between storage and sprinkler head (sprinklered)?*

Yes No N/A

Are combustibles stored at least three feet away from heat sources?*

Yes No N/A

Fire Extinguishers

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

Yes No N/A

Are fire extinguisher locations visible and unobstructed?*

Yes No N/A

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

Yes No N/A

Fire Protection Systems

Does your occupancy have a sprinkler system?*

Yes No

Does your occupancy have a fire alarm system?*

Yes No

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

Yes No N/A

Print your name*

Initial for electronic signature