Business Self-Inspection Business Name (required) Business Address Number (required) Business Street Name (required) Business Zip Code (required) Is mailing address same as business address? (required) Yes No If not what is the mailing address? Business Contact Email (required) Business Phone (required) After Hours Emergency Contact Name (required) Emergency Contact Phone Number (required) Is the building address number posted with a contrasting background clearly visible from the street? (required) Yes No Is the exterior of the building free from weeds, trash, debris or combustible storage? (required) Yes No Are exit aisles and corridors a minimum of 36" wide and clear of obstructions? (required) Yes No Are all exit doors unlocked, marked with exit signs and can easily be opened from the inside? (required) Yes No Are walls intact without holes or open penetrations? (required) Yes No Are ceiling tiles in place? (required) Yes No N/A Is a 30" wide and 36" deep unobstucted access space maintained in front of electrical panel? (required) Yes No Are circuit breakers properly marked? (required) Yes No Are unused circuit breaker spaces properly covered with blanks? (required) Yes No Are cover plates in place for switches, receptacles and junction boxes? (required) Yes No Are extension cords being used as permanent wiring? (required) Yes No Are mechanical rooms, electrical rooms and areas under stairways clear of combustible storage? (required) Yes No Is there a 24" clearance between storage and ceiling (non-sprinklered) or an 18" clearance between storage and sprinkler head (sprinklered)? (required) Yes No Are combustibles stored at least three feet away from heat sources? (required) Yes No Do fire extinguishers have a minimum rating of 2A/10BC? (required) Yes No Are fire extinguisher locations visible and unobstructed? (required) Yes No Have fire extinguishers been serviced and tagged by a qualified contractor within the past 12-months? (required) Yes No Insert a photo of one fire extinguisher (include pressure gauge and service tag in photo) (required) Service Company Name (required) Service Date on Tag (required) Kitchen suppression system (if present): Attach photo of the service tag found on the manual pull station. Kitchen suppression system (if present): Service Company Name Kitchen suppression system (if present): Service date on tag Kitchen suppression system (if present): Service company name for hood and duct cleaning Kitchen Suppression system (if present): Service date on tag for hood and duct cleaning Print your Name (required) Initial for Electronic Signature (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
