Attachment 4 Appendix C PWS Template example of Inspection checklist.pdf
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- Solicitation number
- FA568225Q8027
About this file
This document is an Inspection Checklist for Hood and Duct Cleaning, designed to be completed by a Fire Inspector I or higher. The checklist provides a comprehensive evaluation of ventilation systems and fire safety components in commercial cooking operations, specifically aligned with NFPA 96, Ventilation Control and Fire Protection of Commercial Cooking Operations (2017 edition or later).
The checklist includes 11 detailed inspection items across three main categories: lower duct system inspection, upper duct system inspection, and specific areas of concern. These areas include examining ducts, fans, motors, filters, grease traps, suppression systems, and fire safety equipment. Key inspection points cover cleaning to bare metal, grease-free components, proper positioning of fire suppression nozzles, and secure manual pull stations. The form is specific to Aviano Air Base in Italy and requires one checklist per hood, with the Fire Inspector or Facility Manager having a 20-minute window to conduct the inspection upon notification.
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Text version
INSPECTION CHECKLIST PAGE 1 OF 1 PAGES
TITLE/SUBJECT/ACTIVITY/FUNCTIONAL AREA
Hood and Duct Cleaning (To be completed by a Fire Inspector I or higher)
OPR
CEF
DATE
MMM / YYYY
NO ITEM
(Assign a paragraph number to each item. Draw a horizontal line between each major paragraph.)
YES NO N/A
1 LOWER DUCT SYSTEM - looking up
2 UPPER DUCT SYSTEM - looking down from roof opening
3 SPECIFIC AREAS OF CONCERNS:
a. Look up and down from access points
b. Was duct cleaned to bare metal?
c. Are fans and fan housings free of grease?
d. Are motors free of grease?
e. Are filters/grease traps free of grease?
f. Did employees wipe down hoods so they are free of dust and grease?
g. Are suppression system piping and fusible links free of grease?
h. Did contractor clean grease residue from extractor duct lining and exterior walls/roof?
i. Are fire suppression nozzles pointed directly at cooking surface?
j. Are manual pull stations for each hood secure?
k. Are fire suppression bottles in the "set" position?
Inspection conducted IAW NFPA 96, Ventilation Control and Fire Protection of Commercial Cooking Operations 2017 edition or later edition
Building Number Hood I.D. # Frequency
Establishment Name
Inspector (Rank/Name) (Signature)
REMARKS
Contractor Signature
Notes:
1. One checklist is required per hood.
2. Upon notification of a hood and duct inspection the Fire Inspector or Facility Manager has a 20 minute window to conduct an inspection.
Aviano AB, Italy – In house generated form.
File details come from the government source that posted it. Updated .