Certified Family Home Fire Preparedness Inspection Log
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1C
F
H
F
P
ERTIFIED
AMILY
OME
IRE
REPAREDNESS
I
L
NSPECTION
OG
CFH Provider ___________________________________________
Date __________________
Monthly Smoke Detector
Quarterly Fire Extinguisher
Quarterly Fire Drills
Six-Month Review
Test date & results
Examine & tag initialed
Conduct & document
Emergency Preparedness
600.07a
600.07.b
600.05.
600.04
DATE & YEAR
INITIAL
DATE & YEAR
INITIAL
DATE & YEAR
INITIAL
DATE & YEAR
INITIAL
JAN.
JAN.
JAN.
JAN.
FEB.
FEB.
FEB.
FEB.
MAR.
MAR.
MAR.
MAR.
APR.
APR.
APR.
APR.
MAY
MAY
MAY
MAY
JUN.
JUN.
JUN.
JUN.
JUL.
JUL.
JUL.
JUL.
AUG.
AUG.
AUG.
AUG.
SEPT.
SEPT.
SEPT.
SEPT.
OCT.
OCT.
OCT.
OCT.
NOV.
NOV.
NOV.
NOV.
DEC.
DEC.
DEC.
DEC.
JAN.
JAN.
JAN.
JAN.
FEB.
FEB.
FEB.
FEB.
MAR.
MAR.
MAR.
MAR.
APR.
APR.
APR.
APR.
MAY
MAY
MAY
MAY
JUN.
JUN.
JUN.
JUN.
JUL.
JUL.
JUL.
JUL.
AUG.
AUG.
AUG.
AUG.
SEPT.
SEPT.
SEPT.
SEPT.
OCT.
OCT.
OCT.
OCT.
NOV.
NOV.
NOV.
NOV.
DEC.
DEC.
DEC.
DEC.
Section 5
16
Revised 06/2013
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