Fire Safety

Fire Extinguisher Monthly Inspection

NFPA 10 requires monthly visual inspections of every portable fire extinguisher. This form covers each unit in under two minutes — charge gauge, tamper seal, physical damage, and location accessibility — and produces the documented record that fire marshals and insurers expect.

16 Questions
~5 min To complete
4 Sections
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1

Extinguisher Identification

4 questions
Location / building and floor Required Text
Building C — Second Floor Kitchen, near emergency exit
Extinguisher ID tag or serial number Required Text
EXT-C2-004 — Ansul Sentry 5 lb ABC
Last annual service date Required Date
2024-01-08
Inspector name Required Text
Danielle Park, Facilities Manager
2

Charge & Seal

4 questions
Pressure gauge — in the green (charged)? Required Pass / Fail
✓ Pass
Tamper seal (pull pin) — intact and unbroken? Required Pass / Fail
✓ Pass
Safety pin — fully inserted? Required Yes / No
Yes
Hose / nozzle — no blockage, cracks, or missing parts? Required Pass / Fail
✓ Pass
3

Physical Condition

5 questions
Cylinder — no visible dents, corrosion, or damage? Required Pass / Fail
✓ Pass
Label / operating instructions — legible and facing outward? Required Pass / Fail
✗ Fail Label partially obscured by tape. Tape removed. Label legible.
Inspection tag attached and current? Required Yes / No
Yes
Photo of extinguisher showing gauge and seal Photo
📷 Photo attached
Unit requires service or replacement? Required Yes / No
No
4

Location & Accessibility

3 questions
Extinguisher visible and unobstructed? Required Pass / Fail
✓ Pass
Mounted at correct height (handle at 3.5–5 ft)? Required Yes / No
Yes
Travel distance to nearest extinguisher within code? Required Yes / No
Yes NFPA 10: max 75 ft travel distance for Class A hazards.

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