Smoke Alarm Maintenance Checklist

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SMOKE ALARM MAINTENANCE CHECKLIST
Address/Suite Number: ___________________________
Date:
___________________
Smoke alarm has been tested as a result of:
! routine test and maintenance
! extended absence of occupants
! annual test and maintenance
! complaint _________________________________
! change of tenancy
! other _____________________________________
A.
ROUTINE TEST AND MAINTENANCE
YES
NO
!
!
(1)
Smoke alarm is securely fastened to the wall or ceiling.
(2)
Smoke alarm shows no evidence of physical damage, paint application, or
!
!
excessive grease and dirt accumulations.
!
!
(3)
Ventilation holes on the smoke alarm are clean and free of obstructions.
!
!
(4)
Smoke alarm signal sounds when the test device is operated.
B.
ANNUAL TEST AND MAINTENANCE
YES
NO
!
!
(1)
Smoke alarm is securely fastened to the wall or ceiling.
(2)
Smoke alarm shows no evidence of physical damage, paint application, or
!
!
excessive grease and dirt accumulations.
!
!
(3)
Smoke alarm has been vacuumed.
Smoke alarm is powered by: ! AC wiring; ! standard battery; ! long life
(4)
battery that expires in the year _______. For battery operated smoke alarms:
!
!
Battery has been replaced and securely connected to the clips.
!
!
Battery is of the type ____________________ as recommended by the
manufacturer.
!
!
Battery terminals are free of corrosion and signs of leakage.
(5)
Smoke alarm signal sounds when the smoke alarm is tested using smoke
produced from a burning: ! incense stick, ! punk stick, or ! cotton string.
!
!
C. SERVICING AND REPLACEMENT
(Complete this section if “No” is checked in sections A or
B.)
Smoke alarm has been serviced as follows: _____________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Smoke alarm has been replaced as a result of:
! failure to sound alarm during test
! frequent false alarms
! physical damage
! battery leakage
! painted exterior case
! age
! excessive stains, grease or dirt accumulations
! other_______________________________
Name and Title (please print): _______________________________________
Agency (please print): _______________________________________
Signature: _______________________________________

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