Self Inspection Report Form - City Of Watsonville Fire Department (Page 2 of 2) in pdf

Fire Extinguishers cont.

Yes

N/A

Is the fire extinguisher(s) properly mounted? Proper locations-near exit doors where possible, not

exceeding maximum travel distance, properly mounted (maximum 5’ high if less than 40 lbs.,

maximum 31/2’ high if greater than 40lbs. In all cases, minimum 4” above the ground)?

Fire/Smoke Separations

Are the fire/smoke separations (smoke doors, fire doors, walls, etc.) maintained in working

condition?

Fire Suppression Systems

Is storage maintained a minimum of 18” below head deflectors in fire sprinklered areas?

If the building is equipped with a fire sprinkler system, has the required annual service of the fire

sprinkler system been performed in the last year by a qualified sprinkler company?

In the commercial cooking applications, has the hood suppression system been serviced in the last

six months and is the hood cleaned at intervals to prevent the accumulation of grease? UL 300

compliant.

Heat producing appliances

If portable electric heaters are used, are they used safely? Are they plugged directly into wall outlets

and kept a minimum of 3’ away from combustibles.

House Keeping and Decoration

Is combustible rubbish that is stored in containers outside of vault storage rooms removed from the

building a minimum of once each working day?

Are oily rags or similar materials stored in metal, metal lined or other approved containers equipped

with tight fitting covers?

Are combustible decorations flame retardant?

Mechanical Hazards

Is the venting for exhaust products of combustion working properly for gas appliances? (i.e.: water

heaters, furnaces, etc.)

Smoke Detectors

If smoke detection is required in common areas such as corridors or part of the fire alarm system,

have they been tested in the last year by a qualified technician?

Storage of Combustibles

Is the storage of combustible material orderly and clear of exits and openings?

Are combustible materials not stored beneath the building or structure?

Are the boiler rooms, mechanical rooms and electrical panel rooms maintained free of all

combustible materials?

Are rubbish containers over 5 1/3 cubic feet (40 gallons) provided with lids and made of

noncombustible construction?

Are dumpsters that are 1.5 cubic yards or more not stored inside the building and placed more than

5’ from combustible walls, openings or combustible roof eave lines?

If you have storage of compressed gas containers (such as Co2, helium, etc.) are they chained to

prevent falling?

Storage of Combustible and Flammable Liquids

Are quantities in excess of 10 gallons of flammable and combustible liquids used for maintenance

purposes and the operation of equipment stored in liquid storage cabinets?

A “NO” response to any of these questions indicates the presence of a fire code safety hazard. Once all

hazards identified as having a “NO” response are corrected, please sign, date, and return this form to us.

Thank you for your cooperation. Completion of this form does not eliminate all fire inspections conducted by

the Watsonville Fire Department. If you are a located in a residence, please contact us prior to mailing

payment and/or form.

Print name of Responsible person: _________________________________________________________

Signature: ___________________________________________________ Date: _____________________

Enclosed Check #______________________ Amount of Check $___________ ($37.00, per address)

If you have any questions, please contact Rudy Lopez Sr., Division Chief of Fire Prevention / Fire

Marshal. 831-768-3231

City of Watsonville

250 Main Street

Watsonville, CA. 95076

Self Inspection Report Form - City Of Watsonville Fire Department Page 2

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