Smithfield Fire Rescue Home Business Inspection Form
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1SMITHFIELD FIRE RESCUE
PO Box 96
435-563-3056
325 West 100 North
Fax: 435-563-2528
Smithfield Utah 84335
HOME BUSINESS INSPECTION
Please inspect your home business to be certain that fire safety is at the highest standards. Upon
completion, please return this form for review. If you have questions, please contact us.
Business name:___________________________________ Address:____________________________
Business contact person:___________________________ Phone #___________________
Type of business:_________________________________ Date:______________________________
GENERAL
WATER HEATER
Y
N
Y
N
Address visible(Min. 1"x4" numbers)……………………………….
3ft. clearance around water heater………………...……….
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Unobstructed Fire Hydrant(Min. 3ft clearance)……………………
Proper setting(medium)…………………………………...…
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Access to the building is Clear Visible…………………………..….
Properly braced for earth quakes…………………………..
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Fire Extinguishers Class 2A10BC(minimum of one)….…………..
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Fire Extinguisher Mounted 36" to 42" above floor….……………..
FURNACE & HEATING APPLIANCES
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Fire Extinguisher Inspected Annually….……………………………
3ft. clearance around furnace or heater……………………
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Fire Extinguisher Readily Accessible………………………………
Accessible gas shut off………………………………………
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Proper furnace filter maintenance…………………………..
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FLAMMABLE/COMBUSTIBLE LIQUIDS
Follow manufacturers instructions……………………….…
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Proper storage and containers………………………………………
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(All flammable and combustible liquids shall be stored in garage
STOVES & FIREPLACE
area away from heat & flame. This includes Gasoline, Diesel,
Proper fuel storage clearance……………………….……...
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Kerosene, Propane, Paints, Thinners, and Aerosol cans).
Annual maintenance & inspection of Chimney……………
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Proper installation…………………………………………….
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ORDINARY COMBUSTIBLES
Safe disposal of ashes……………………………………….
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Storage of oily rags(Metal containers w/ lid)………………….……
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Orderly housekeeping………………………………………………..
EVACUATION PLAN
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No storage under unsheetrocked stairs……………………...…….
Smoke detectors installed & working…………………..…..
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Smoke detectors installed in hallways and close to
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ELECTRICAL
sleeping areas…………………………………………..........
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Breaker circuits labeled………………….………..………………….
Carbon monoxide detector installed and operational…….
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No open spaces in breaker panel……………..………….…………
Evacuation plan developed and practiced…………………
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Electrical Circuit breakers move freely …………...……………..…
Exits not obstructed…………………………………………..
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Breaker box unobstructed……………………………………………
Special needs identified………………………………….….
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Proper extension cord use(temporary use only, power strips are
Doors open easily and in good repair………………………
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allowed)…………………………………………………………..........
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No overloaded outlets……………………………..…………………
COMMENTS
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Grounded cords used(UL listed)………………………….…….......
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No frayed or broken wires………………………………….….…….
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Wall outlets and light switch cover installed……………..………...
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Does your business produce flammable or combustible gases or dust?
YES
NO
If yes, what
types?_____________________________________________________________________________________________________
Do you store flammable liquid or gases? YES
NO
If yes, what types and how much?____________________________
_____________________________________________________________________________________
I hereby certify that I have truthfully and physically completed this inspection and have seriously addressed every item. I
further certify that I have corrected every item marked "N" on this form and that my home and place of business are in good
repair and that there are no obvious fire hazard.
Inspection completed by: ___________________________________
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