Self Inspection Form (Page 5 of 5) in pdf

Self Inspection Form Page 5

This fire prevention survey was made for the purposes of promoting fire safety and to assist the

owner/manager in correcting conditions, which may contribute to a fire. The list is intended to cover the

most common items/hazards we encounter when performing fire inspections in low hazard occupancies.

It may contain a list of items that must be corrected to bring the safety conditions up to the minimum

standards prescribed by the International Fire Code and Village/County Ordinances. This inspection does

not alleviate the owner/manager’s ongoing obligation to locate and correct safety hazards.

If you have any questions, please call 815.468.7100 between 7am and 4 pm Monday through Friday.

Inspected by:______________________________ _____________________________________

Signature

Date of Inspection:__________________________

I request a follow up call concerning my self-inspection.

I request more information on the Knox Box Rapid Entry Program.

I request information pertaining to the extinguisher training program.

Contact information:_______________________________________________________________

_______________________________________________________________________________

CONFIDENTIAL

5 of 5

6/1/2015

Self Inspection Form Page 5