Self-Fire Inspection Form

Instructions: Fill in all the information on the form. Walk through your occupancy to ensure the safety requirements on the checklist are fulfilled. If an item is compliant, check the "Yes" box. If an item is non-compliant, either remedy the problem before submitting this form or check the "No" box and we will follow up ensuring the hazard is corrected. If an item does not apply, check the "N/A" box. Any hazard not addressed in the questions can be typed into the "Additional Comments" box. Click on the "View Information" link for each section if you need additional code information. When completed, click on the "Submit" button to automatically E-mail your form to the Tracy Fire & Life Safety Division. Thank you for participating!

Date

Business name

Business Address

Street Address City Province Postal Code

Business Phone

Business Email

Emergency Contact Names & Phone Numbers (After-hours Responsible Parties to be contacted by Dispatch if necessary)

Emergency Contact #1 Name*

First Last

Emergency Contact #1 Phone*

Emergency Contact #2 Name

First Last

Emergency Contact #2 Phone

Emergency Contact #3 Name

First Last

Emergency Contact #3 Phone

Access & Premises:

Is the exterior fire department access road unobstructed?*

Yes
No
N/A

Is there maintained a minimum 3' clearance around fire hydrants?*

Yes
No
N/A

Are address numbers for the building clearly visible from the street?*

Yes
No
N/A

Is combustible vegetation removed so as to not create a fire hazard?*

Yes
No
N/A

For more information about Access & Premises click here: Access & Premises.pdf

Egress/Exit Requirements:

Are doors with self-closing hinges maintained in the closed position (not blocked open)?*

Yes
No
N/A

Are the exitways and doors easily recognizable, unobstructed, and maintained functional?*

Yes
No
N/A

If the main exit door is provided with key-locking hardware as allowed by code, is there a sign above the door that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED" and are the other exit doors openable from the inside without the use of a key or any special knowledge or effort?*

Yes
No
N/A

Are the other required exit doors readily openable from the inside without the use of a key or special knowledge or effort?*

Yes
No
N/A

Are the exits and exit enclosures free from the storage of combustible materials?*

Yes
No
N/A

Is the means of egress illuminated when the building or structure is occupied?*

Yes
No
N/A

In residential occupancies, are emergency escape or rescue windows, doors or window wells required by the Building Code for sleeping rooms maintained openable and free from any obstruction that would inhibit the occupant from escaping?*

Yes
No
N/A

For more information about Egress/Exit Requirements click here: Egress/Exit Requirements.pdf

Fire/Smoke Separations:

Are the Access to Exits and Exit Doors clear of obstructions?*

Yes
No
N/A

For more information about Fire/Smoke Separations click here: Fire/Smoke Separations.pdf

Self-Fire Inspection Form

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