AFRICA QHSE DEPARTMENT

EXTINGUISHER INSPECTION CHECKLIST FORM

Document N°: HSE-F-0001 Rev 01

A – IDENTIFICATION
Extinguisher Number: Make:
Department: Type:
Location: Capacity:
Service Frequency: Inspection date:

B – ITEMS TO BE INSPECTED
Conditions Comments
Surrounding environment and parts of the
extinguisher Poo
Good N/A
r
Accessibility
Visibility
Extinguisher Signaling/demarcation
Extinguisher installation
Numbering
Instruction label
Conformity Seal
Internal Condition
Anti-Sabotage Seal Intact
Physical/External condition
Discharge Hose
Discharge Nozzle/Horn
Carrying Handle/Squeeze Grip Release Lever
Pressure Reading
Locking Pin/Clip
Horn firmly attached (CO2)
Horn Clip

C – VALIDATION

Inspector’s name + Supervisor’s name +

Signature Signature