Dept./ Location: Vistamarine Total No.

of Extinguisher Installed/ Issued: 5 Date of Inspection:

Instruction: Write P- if okay or in good working condition and/or available; X - if with problem; N/A - if Not Applicable.
Inspection Result *
Weight Discharge
No. Type Location Date Delivered Expiration Date Discharge Locking Discharge Pressure Carrying Data Inspectio Access- Installat Hydrostat
(lbs) Nozzle & Body Content Signage Remarks
Lever Pin Hose Gauge Handle Plate n Tag ibility ion ic Testing
Orifice
1 Dry Chemical 10lbs Guard house Nov. 2023 Nov. 2024
2 Dry Chemical 10lbs Warehouse Nov. 2023 Nov. 2024
3 Dry Chemical 10lbs Office Nov. 2023 Nov. 2024
4 Dry Chemical 10lbs Machine Shop Nov. 2023 Nov. 2024
5 Dry Chemical 10lbs Hot works kit Nov. 2023 Nov. 2024

* Inspection shall include, but is not limited to:

a) Discharge Lever - no dirt or corrosion which might impair freedom of movement.
b) Locking Pin - in place & properly secured; not broken or missing.
c) Discharge Hose - no damage; no cracks or thin spots; connection between hose & shell is secure.
d) Discharge Nozzle & Orifice - clear & unobstructed; no damage.
e) Pressure Gauge - in the operable position (i.e. dial of the gauge is in the green section).
f) Carrying Handle - intact; not bent or broken.
g) Data Plate - label & operating instructions is clear & readable.
h) Body - no rust or any type of corrosion build up; no visible dents or cracks.
i) Content - full (determined by weighing or hefting).
j) Inspection Tag - current inspection tag is attached; date of inspection, findings & inspector’s initial is recorded.
k) Accessibility - fire extinguisher is unobstructed & accessible.
l) Installation - hung on a bracket or stand-mounted; in the correct height; in the designated place at all times when
not in use; tires, wheels, carriage, etc. (for wheeled units) are in good condition.
m) Signage - signage posted indicating the location of the extinguisher.
n) Hydrostatic Testing - hydrostatic test result is available & updated.

Inspected by: Noted by:

Safety Officer Jezreel Tolentino Engr. Demosthenes Lipura
Safety Officer (Name, Signature & Date) Manager/ EHS Chairman (Name, Signature & Date)