Smoke Detector Inspection Form
Inspector Name
First Name
Last Name
Inspection Date & Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location
Please Select
ABC School Street: 2128 Jewell Road Minneapolis, Minnesota(MN), 55402
XYZ Hotel 4816 Larry Street Oakland, California(CA), 94612
MNO Company 1775 Golden Ridge Road Albany, New York(NY), 12207
Smoke Detector ID
Reason for Inspection
Routine test and maintenance
Extended Absence of Occupants
Annual test and maintenance
Complaint
Change of tenancy
Other
Last Inspection Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
General Inspection
Yes
No
Notes
Smoke alarm is securely fastened to the wall or ceiling.
1
2
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
3
4
Ventilation holes on the smoke alarm are clean and free of obstructions.
5
6
Smoke alarm signal sounds when the test device is operated.
7
8
Actions
Yes
No
Notes
Battery Changed?
9
10
Replaced?
11
12
Take Photo or Upload a Photo
Additional Notes & Comments
Date
-
Month
-
Day
Year
Date
Signature
Submit
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