Rock Island Fire Department
Fire Prevention Bureau
2020 Business Self-Fire Inspection Form
Rock Island Fire Department
Email address *
Name of person completing self-inspection *
Business Name *
If this is a multi-family residential building, list name of building.
Business Address *
This is the address of the property you are self-inspecting.
Business Email Address
An email address for preferred communication between the fire department and your business.
Business Phone number *
Business Owner *
Name of person who owns the 'business'
Business Owner Phone Number *
Building Owner Name
Only answer if different person than business owner.
Building Owner Phone Number
Only answer if different person than business owner.
Emergency Contact Name *
This is the person who would respond to your building in an emergency.
Emergency Contact Phone Number *
2nd Emergency Contact
2nd Emergency Contact Phone Number
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