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No :

FIRE EXTINGUISHER INSPECTION RECORD Revisi :


Date :
Location :
Condition Good / Bad / N/A

pressure Guage

Expire date
Handle
Nozzle

Hoses
No Location Type PTHB No. Cap (Kg) Unit

Tube
Remarks

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Note : G = Good , F = Fair , B = Bad , N/A = Not Available


This inspection is only done visually for technical inspection carried out by persons / agencies authorized /
institutions,or local authorities

Inspected by,
Name : Position : Signature :

Witness by,
Name : Position : Signature :

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