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INSPECTION CHECKLIST 2008

Date ___________ , 2008


Pg. _______ of ________

BUILDING NAME ______________________________________

Door Number Fire-Rating Door Location Compliant


❏ YES ❏ NO

Remarks:

FRAME DOOR (cont.) HINGES/PIVOTS LOCKS FIRE EXIT HARDWARE ((cont.) MISCELLANEOUS

E
❏ Loose Frame ❏ Loose Light Kits ❏ Missing Hinge(s) ❏ Missing Lock ❏ Other ________________ ❏ Missing Threshold/ Saddle
❏ Damaged Frame ❏ Missing Light Kit Screw(s) ❏ Incorrect Hinge(s) ❏ Incorrect Latch Bolt Throw ❏ Incorrect Clearance
❏ Rust-through on Frame ❏ Improper Field ❏ Loose Hinge(s) ❏ Non-fire Rated Latch Bolt _____________________ (Top of Door to Frame)
Modification (Explain ❏ Incorrect Clearance

L
❏ Missing Label ❏ Missing Screw(s) ❏ Latch Bolt Binds _____________________
Modification) (Hinge Edge to Frame)
❏ Frame is Out of Alignment ❏ Replace Hinge(s) ❏ Latch Bolt Missing
❏ Incorrect Hardware ❏ Incorrect Clearance (Lock
❏ Incorrect Glass in Sidelight Preparation (Explain) ❏ Loose Lever(s) or Knob(s) Edge to Frame)
or Transom-light ❏ Other ________________ ❏ Missing Door Closer(s)
❏ Unused Fastener Hole(s) ❏ Latch Bolt Does NOT ❏ Incorrect Clearance (Door
❏ Broken Glass in Sidelight Engage Strike ❏ Leaking Door Closer(s)
in Door(s) _____________________ Bottom to Floor)

P
or Transom-light ❏ Missing Strike Plate ❏ Missing Arm(s)
❏ Improper Plant-ons ❏ Incorrect Clearance
❏ Missing Glazing Bead at _____________________ ❏ Missing Screw(s) ❏ Broken Arm(s) (Between Doors)
Light(s) ❏ Replace Door
❏ Missing Flush Bolt ❏ Missing Closer(s) ❏ Missing Astragal
❏ Missing Glazing Bead ❏ Other ________________ ❏ Does NOT Close Door
Screw(s) DOOR BOLTS ❏ Missing Flush Bolt Strike ❏ Missing or Damaged
Completely Gasketing/Smoke Seal
❏ Improper Field _____________________ ❏ Missing Top Flush Bolt ❏ Other ________________ ❏ Missing Screw(s)
Modification (Explain ❏ Kick-down Door Holder

M
❏ Missing Bottom Flush Bolt ❏ Missing Drop and/or
Modification) _____________________ _____________________ ❏ Door Wedge
❏ Missing Strike (Top Bolt) Adapter Plate(s)
❏ Incorrect Hardware ❏ Door Stop with Hold Open
Preparation (Explain) ❏ Missing Strike (Bottom ❏ Hold-open Arm(s) (Manual)
_____________________
OPERATIONAL TEST Bolt) ❏ Missing Coordinator
❏ Unused Fastener Hole(s) ❏ Protection Plate(s)
in Frame ❏ Door Does NOT Swing ❏ Bottom Bolt does NOT ❏ Missing Carry Bar too Large

A
Freely Engage Strike FIRE EXIT HARDWARE Broken Coordinator
❏ ❏ Protection Plate(s) Missing
❏ Other ________________ ❏ Missing Bolt Head (Top) ❏ Missing Fire Exit Device screw(s)
❏ Door Does NOT Close ❏ Broken Carry Bar
Completely ❏ Missing Bolt Head ❏ Missing Latch Bolt ❏ Overhead Hold-open ❏ Signage Too Large
_____________________ (Bottom)
❏ Door Does NOT Securely Assembly (Top) (Surface or Concealed) ❏ Signage, Screwed/Nailed
Latch ❏ Missing Rub Plate(s) ❏ Missing Latch Bolt to Door

S
_____________________ ❏ Other ________________
❏ Electric Door Release ❏ Incorrect Type of Flush Assembly (Bottom)
Does NOT Allow Door to Bolt(s) ❏ Missing Strike(s) ❏ Other ________________
DOOR Close _____________________
❏ Other ________________ ❏ Missing Vertical Rod (Top) _____________________
❏ Missing Door(s) ❏ Door Bottom Drags ❏ Missing Vertical Rod
Against Floor Material _____________________
❏ Missing Label _____________________ (Bottom) _____________________
❏ Door Rubs Against Frame ❏ Push Bar Does NOT
❏ Damaged Door(s) (e.g.,
Dented, Bent) ❏ Edges of Paired Doors _____________________ Extend Halfway Across
Overlap Door Width
❏ Rust-through on Door(s)
❏ Coordinator Does NOT ❏ Non-fire Rated Panic
❏ Delamination of Door Skin Function Properly
or Face Hardware (Dogging)
❏ Incorrect Glass in Light(s) ❏ Other ________________ ❏ Missing Lever or Knob
❏ Broken Glass in Light(s)
❏ Light(s) is/are Too Large _____________________

FORM 4
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© COPYRIGHT 2008 THE DOOR AND HARDWARE INSTITUTE. ALL RIGHTS RESERVED.
(“White” copy is ORIGINAL • “Pink” copy is DUPLICATE COPY • “Yellow” copy is INSPECTOR’S COPY) Use of this inspection form without the express written consent of the Door and Hardware Institute is strictly forbidden.