Self-Fire Inspection Worksheet Template - City Of Jerome Fire Department
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3City of Jerome Fire Department
City of Jerome
City of Jerome
City of Jerome
110 W. Yakima Ave, Jerome, Idaho 83338, Phone: (208)324-2323 Fax: 324-4258
Self-Fire Inspection Worksheet
Version 01-2015
Business Name:
Business Phone #:
Address:
E-mail:
1. After-Hours Emergency Contact:
Contact Phone #:
2. After-Hours Emergency Contact:
Contact Phone #:
All businesses are encouraged to fill out and submit this inspection form. Fill in all the information on the form. Walk
through your occupancy to ensure the safety requirements on the checklist are fulfilled. If an item is in compliance, check
the “Yes” box. If an item is non-compliant, either remedy the problem before submitting this form or check the “No” box
and we will follow up in ensuring the hazard is corrected. If an item does not apply, check the “N/A” box. Any hazard not
addressed in the Self-Fire Inspection Form may be entered under “Additional Comments”
When completed, please drop off at Jerome City Fire Headquarters (110 W. Yakima Ave.). You can also fax it to 208-
324-4258 or scan/email to fireprevention@ci.jerome.id.us. Thank you for participating!
The list is intended to cover the most common items/hazards we encounter while performing fire inspections in low
hazard occupancies. It is not intended to be all comprehensive or replace specific code requirements not addressed on
the form. If you have specific code related question not addressed on this form, please call 208-324-2323 EXT-135.
Access & Premises
Yes
No
N/A
Are address numbers for the building clearly visible from the street?
Is the exterior fire department access unobstructed?
If the building has a Knox Box, are the building keys inside the box current?
Is combustible vegetation removed so as to not create a fire hazard?
Is there maintained a minimum 3' clearance around fire hydrants?
Egress (Exiting)
Yes
No
N/A
Are the exit ways and doors easily recognizable, unobstructed, and maintained functional?
If the main exit door is provided with key-locking hardware as allowed by code, is there a sign above the
door that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED" and are the
other exit doors openable from the inside w/o the use of a key or any special knowledge or effort?
Are the exits and exit enclosures free from the storage of combustible materials and obstructions?
Are doors with self-closing hinges maintained in the closed position (not blocked open)?
Electrical
Yes
No
N/A
Are all electrical outlets, switches and junction boxes properly covered with cover plates and is the
electrical system safe from any apparent shock and/or other electrical hazards?
Are circuit breakers/fuses labeled so as to identify the area protected?
Is the area maintained clear at least 30" in front of electrical panel(s)?
Are extension cords used only for temporary use?
Are extension cord(s) of heavy duty construction, maintained in good condition, and only used
as temporary wiring, or to service small portable appliances?
Are extension cord(s) grounded when serving grounded appliances?
Are extension cord(s) plugged directly into an approved receptacle, power tap or multi-plug adapter
and, except for approved multi-plug extension cord(s), serve only 1 portable appliance?
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