FIRE DAMPER INSPECTION FORM
Client's Name
First Name
Last Name
Client's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Client's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
EVALUATIONS
Fire Damper No
Fire Damper Size
Fire Damper Location
Please choose the most appropriate option and fill in the blanks if necessary.
Rows
Fail
Pass
N/A
Notes
1) Damper is working properly. No anti-run material can enter the damper frame.
1
2
3
2) Exposed moving parts are lubricated according to instructions.
4
5
6
3) There is no problem in opening and closing the smoke damper. It is working properly. (According to NFPA 72)
7
8
9
4) There are no parts that can cause problems with the operation of the dampers. (Rusty or bent parts, incorrectly assembled parts, defective hinges, damaged blades)
10
11
12
5)There are no adjustments made to the fusible link. It has not been damaged or painted. If it was found to be damaged, it was replaced.
13
14
15
6) There are no problems with accessing the dampers. Fully unobstructed-free access is provided.
16
17
18
7) Deficiencies and ways of correcting them are noted. If any corrections have been made, it has been checked that the damper is working properly.
19
20
21
8) Fusible link, if provided, is removed and damper closes completely and latches closed. (where latch provided)
22
23
24
Findings & Comments
Inspector's Company Name
Inspector's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Inspector's Name
First Name
Last Name
Inspector's Signature
Submit
Should be Empty: