36C24420Q0295-007.docx

Annual Inspection of Swinging Fire Door Assemblies

Name of Property:

Fire Door Assembly Location:

Special Locking Arrangement?:

Number of Leafs: Fire Rating of Each Leaf: Fire Rating of Frame:

Rating of Barrier: Purpose of Rated Barrier:

Self-Closing / Automatic-Closing / Power-operated (circle one) Hold-open Device?: Yes or No (circle one)

Inspected By: Date:

1. Labels are clearly visible and legible?

2. Is the door and frame free from holes and breaks in all surfaces?

3. Are all the glazing, vision light frames and glazing beads intact and securely fastened?

4. Are the doors, hinges, frame, hardware and threshold secure, aligned and in working order with no visible signs of damage?

5. Are there any missing or broken parts?

6. Is the clearance from the door edge to the frame no more than 1/8 inch?

7. Door undercut is maximum ¾ inch and meeting stiles clearance is maximum ⅛ inch?

8. Is the self-closing device operational? Does the active door leaf completely close when operated from the full open position?

9. Does the inactive leaf close before the active leaf when a coordinator is used?

10. Does the latching hardware operate and secure the door in the closed position?

11. Is the door assembly free from are auxiliary hardware items which could interfere with its operation?

12. Has the door been modified since it was originally installed?

13. If gasketing and edge seals are installed, have they been verified for integrity and operation?

14. Signage does not exceed 5% of the door face; does not impair or interfere with proper operation, and is attached with adhesive (not mechanical attachment)?

Source: NFPA 80, 2016 edition

Comments:

Supervisor’s Initial: Date: Work Order #:

Attachment C