UC Irvine – Environmental Health and Safety

Fire and Life Safety Field Meetings, Inspections, and Facilities Closeout Program

Appendix A – Request for Inspection Form

INSPECTION REQUEST
DATE: REQUEST NO.:
PROJECT: JOB NO.:
PROJECT CONTRACTOR
NO: :

ATTENTION

DATE REQUESTED FOR

INSPECTION:
TIME REQUESTED FOR † AM/ † PM
INSPECTION:
TYPE OF INSPECTION
REQUESTED:
SPECIFICATION SECTION:

LOCATION OF
INSPECTION:

All work requested for inspection has been reviewed for compliance with the construction
Documents by prior to this request for inspection.

SIGNATURE: DATE:

UCI USE ONLY

DATE OF INSPECTION: TIME:

INSPECTOR:

COMMENTS:

INSPECTION REPORT YES NO

ATTACHED