Attachment C Sample Fire-Door-Inspection-Form.docx
DOCX document 25 KB Posted
- Attached to
- Annual Inspection of Fire Doors and Quarterly Penetration Inspection of Fire and Smoke Barriers
- Solicitation number
- 36C24426Q0670
About this file
This is a sample inspection form template for the annual inspection of swinging fire door assemblies, provided as Attachment C to the solicitation for fire door and fire/smoke barrier inspection services. The form is based on NFPA 80, 2016 edition standards and serves as a standardized checklist for evaluating fire door condition and compliance.
The form captures essential inspection data including property name, fire door assembly location, door configuration details (number of leafs, fire ratings of components, barrier rating and purpose), and operational specifications (self-closing/automatic-closing/power-operated status and hold-open device presence). The inspection checklist includes 14 yes/no/N/A items covering label visibility and legibility, structural integrity (holes, breaks, glazing), hardware security and alignment, clearance tolerances, self-closing device operation, latching hardware functionality, absence of interfering auxiliary hardware, modification history, gasket and seal integrity, and signage compliance. The form concludes with sections for inspector comments, supervisor initials, date, and work order number. This template does not address pricing, response dates, or contractual terms, but rather establishes the inspection methodology and documentation requirements that contractors will use to perform the services specified in solicitation 36C24426Q0670 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4.
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Text version
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:
| Inspection Activity: |
| Yes |
| No |
| N/A |
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
File details come from the government source that posted it. Updated .