APPENDIX (Fire EXTINGUAISHER MAINTENANCE INSPECTION CHECKLIST)

To be completed by the Inspector at the time of Inspection

Attach additional sheets, data or calculation as necessary to provide a complete record

FACTORY INFORMATION
Factory Name: NRN Knitting & Garments Ltd.
Address: 181 Jamgora, Ashulia, Savar, Dhaka
Representative Name: Prottoy Chakrabarty
Designation: Fire Safety Officer
Phone: 01628610332 Fax: _______________
E-mail: prottoyeng440@gmail.com

INSTALLATION, SERVICE AND TESTING CONTRACTOR INFORMATION (IF

APPLICABLE)
Contractor Name: Self
Address: 181 Jamgora, Ashulia, Savar, Dhaka
Inspector or Tester Name: Prottoy chakrabarty
Qualification of Inspector or Tester: Diploma in Electrical
Phone: 01628610332 Fax: _______________
E-mail: prottoyeng440@gmail.com
A Contract for Inspection & testing in accordance with NFPA is in effect as of: N/A
The Contract Expires: ________________Frequency of Test: Monthly
WITNESS BY
Company Name: NRN Knitting & Garments Ltd.
Address: 181 Jamgora, Ashulia, Savar, Dhaka
Representative Name: Noor Hossain
Designation: HR Officer
Phone: 01683387239 Fax: _______________
E-mail: compliance@nrnbd.com

As per NFPA standard No. 1 1 0, A functional test shall be conducted on every required Potable
Fire Extinguisher at 30-day intervals for a minimum of 30 seconds. Equipment shall be fully
operational for the duration of visual test. Written records of visual inspections and tests shall be kept
by the owner for inspection by the authority having jurisdiction.

MAINTENANCE INSPECTION CHECKLIST

Comments
Sl No Description YES NO N/A
1 Location in designated place
2 No obstruction to access or visibility
3 Operating instructions on nameplate legible and facing outward
 4 Safety seals and tamper indicators not broken or missing
5 Fullness determined by weighing or “hefting”
Examination for obvious physical damage, corrosion, leakage, or
6
clogged nozzle
7 Pressure gauge reading or indicator in the operable range or position
Condition of tires, wheels, carriage, hose, and nozzle checked (for
8 wheeled units)
9 HMIS label in place

Disclaimer: The list is not all encompassing due to the extensive list of adopted codes. The Inspector shall
documents all fire and life safety violations and corrections when any are discovered during inspection.

Inspector’s Signature Factory Owner’s Signature

Date: Date: