TE-11-12_PORTABLE FIRE EXTINGUISHER ANNUAL INSPECTION.pdf

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FACILITY INVESTMENT SERVICES FOR THE 63RD READINESS DIVISION (RD) FOR REGION 5
Solicitation number
W9127S21Q0057
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63rd Readiness Division Fire Protection Systems

Portable Fire Extinguisher Annual Inspection

FACID

Building Number

Date of Inspection

Complete the remainder of this page once inspection is complete.

Results

Evaluation & Notes:

Inspector Name

Inspector Signature

Witness Name

Witness Signature

Y N/A N

Fire extinguishers are in designated locations Fire extinguishers are accessible and free of obstructions to visibility Pressure gauge reading or indicator checked for all extinguishers Fullness determined by weighing or hefting all extinguishers Condition of tires, wheels, carriage, hose, and nozzle for wheeled extinguishers

Number of fire extinguishers inspected Number of fire extinguishers requiring recharge only Number of fire extinguishers requiring hydro test and recharge Number of fire extinguishers requiring 6 yr. maintenance

Annual Fire Extinguisher Inspection

I = Annual Inspection, H = Hydro Test & Recharge, R = Recharge only, M = 6 yr. Maintenance Extinguisher Model/Type/Size

MFR

Date

Serial

Extinguisher Location

Service Performed

Next Hydro Due

Next 6 Year Due

Notes

Annual Fire Extinguisher Inspection

I = Annual Inspection, H = Hydro Test & Recharge, R = Recharge only, M = 6 yr. Maintenance

Extinguisher Model/Type/Size

MFR

Date

Serial

Extinguisher Location

Service Performed

Next Hydro Due

Next 6 Year Due

Notes

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