City of Gearhart Fire Department
Business Self-Inspection Checklist
Business Name: *
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Address: *
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Phone #: *
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E-Mail: *
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Business License No.: *
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1. Emergency Contact Name: *
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1. Emergency Contact Phone #: *
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2. Emergency Contact Name:
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2. Emergency Contact Phone #:
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3. Emergency Contact Name:
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3. Emergency Contact Phone #:
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Access & Premises:
Are address numbers for the building clearly visible from the street? *
Are fire lanes clear for emergency vehicles? *
Is combustible vegetation removed so as to not create a fire hazard? *
Is there a maintained minimum 3-feet clearance around fire hydrants? *
If you have a fire department knox box, have the building keys been updated? *
Egress (Exiting):
Are exit signs clearly visible and in working order? *
Does the battery back-up for the exit sign work? (Push the test button and the exit sign should continue to illuminate under battery power). *
Is the exit sign illuminated when the building is occupied? *
If emergency lighting is provided, is it maintained in operable condition? *
Are exit pathways free of obstructions and lit in hours of darkness? *
Do fire doors self-close and latch freely and completely when released? *
Are fire doors kept clear and never propped open? *
Are exit stairwells kept clear and not used for storage? *
Are all fire department egress pathways kept clear and not obstructed? *
Fire Suppression and Alarm Systems:
If your building has a fire sprinkler system, is the top of storage maintained a minimum of 18" below the fire sprinkler head deflector? *
If the building is equipped with a fire alarm system, has the required annual service of the fire alarm system been performed by a qualified fire alarm company? *
If the building is equipped with a fire sprinkler system, has the required annual service of the sprinkler system been performed in the last year by a qualified sprinkler company? *
In the kitchen, has the hood suppression system been serviced in the last six months and is the hood cleaned at intervals to prevent the accumulation of grease? *
Has a copy of semi-annual and/or annual service testing been sent to the fire department? *
Fire Extinguishers:
Are all fire extinguishers visible and accessible (not blocked)? *
Have you inspected fire extinguishers monthly to ensure they are charged and ready for use? *
Smoke Alarms:
Are working smoke alarms present in all sleeping units? *
Have the batteries been replaced at least annually? *
Have the smoke alarms been cleaned and tested at least once a year? *
Are lint traps and spaces around laundry appliances clean and free of lint and debris, including all vents? *
Mechanical Hazards:
Are safe clearances maintained between gas-fires appliances such as water heaters, furnaces, and combustible materials? *
Are the boiler rooms, mechanical rooms and electrical panel rooms maintained without the storage of any combustible materials within? *
Heat Producing Appliances:
If portable electric heaters are used, are they used safely? *
Are portable electric heaters plugged directly into wall outlets? *
Is there a minimum of 3 feet of clearance between heaters and combustibles? *
Electrical Hazards:
Are all electrical outlets, switches and junction boxes peoperly covered with cover plates? *
Is the area clear at least 30 inches in front of the electrical panel(s)? *
Are extension cords used only for temporary use? *
If multiple items need to be plugged in, does the surge protector have a built-in circuit breaker and is plugged directly into an outlet? *
Storage of Combustibles:
If your building does not have a fire sprinkler system, is the top of storage maintained a minimum of 24" below the ceiling? *
Are dumpsters that are 1.5 cubic yards or more stored outside of the building and placed more than 5 feet away from the walls of the building, windows, doors or combustible roof eave lines? *
Storage of Compressed Gas cylinders:
Are compressed gas containers (such as carbon dioxide, helium, etc.), chained to prevent from falling? *
Are compressed gas cylinders containing propane and butane being stored outside in a storage area not open to the public? (Small 16.4 ounce tanks are allowed within a building open to the public for retail sales). *
Storage of Combustible and Flammable Liquids:
Are quantities in excess of 10 gallons of flammable and combustible liquids used for maintenance purposes and the operation of equipment stored in liquid storage containers? *
Fire Safety Training & Evacuation Plan:
Is your required Fire Safety and/or Evacuation Plan up to date and readily available and/or posted? *
Are evacuation diagrams posted for every sleeping unit? *
Do you know where your outdoor assembly area is located in the event of an emergency? *
Is tsunami evacuation information available in every sleeping room? *NOT A FIRE CODE REQUIREMENT
A "No" response to any of these questions indicates the presence of a fire code violation. Once all hazards identified as having a "No" response are corrected, Please sign, date, and Submit this form.
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