Portable Fire Extinguishers

Monthly Inspection
Date_____________________ Facility_____________________________________________________________ Building_____________________________________________ Checkpoints Extinguishers are located in their designated places. There are no obstructions to the extinguisher access or visibility. Operating instructions on nameplate are legible. Seals and tamper indicators are not broken or missing. Examine for obvious physical damage, corrosion, leakage, or clogged nozzle. Pressure gauge reading or indicator in the operable range or position. Is extinguisher full? (Determine fullness by hefting, and, if needed, by weighing.) Determine if hydrostatic testing is required. Operating instructions on nameplate facing outward. Recommendations N/A Yes No

Note: Attach a listing of the extinguishers that were inspected in accordance with this form. Inspected by_________________________________________________________________
(Print name and company)

Signature_____________________________________________ Date__________________

Copyright 2003 American Institute of Chemical Engineers