Fire Barrier INSP Form.pdf

This is a Fire Barrier Inspection Form template used for periodic maintenance and compliance verification of fire barrier systems within federal facilities.

The form captures essential inspection data including facility identification (facility name, building, floor, location/stairwell), inspector credentials (name and signature), and the inspection date. Inspectors document overall barrier compliance status and whether repairs were performed. The inspection checklist requires Pass/Fail/N/A designations for six critical evaluation points: visual confirmation of fire barrier presence in both the identified location and adjoining rooms, absence of primary penetrations (defined as holes, cracks, or chipping preventing 100% barrier completeness) in both locations, and absence of secondary penetrations (uncapped utility stub outs) in both locations. When non-compliance is identified, inspectors must document failure descriptions and any repairs performed, including repair completion dates and responsible parties. The form includes a note addressing inspection limitations related to hard ceilings with access panels and provides clear definitions of penetration types. Upon completion, all forms must be submitted to the Carpenter Shop Supervisor for verification and upload into the facility's records management system.