Fireplace Outside Air Intake Inspection Form

Fireplace Outside Air Intake Inspection Form
Complete this form to document the inspection and assessment of a fireplace's outside air intake. Ensure all findings and recommendations are accurately recorded.
Property Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Client Name
First NameLast Name
Inspection Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Inspector Name
First NameLast Name
Location of Outside Air Intake
Is the outside air intake accessible?
Condition of Air Intake Cover/Screen
Input Table: Inspection Checklist
Rows Pass Fail N/A
Air intake is free from blockages
No signs of pest or animal intrusion
Ducting is properly connected
No visible damage to intake duct
Are there any obstructions or debris present?
Notes and Observations
Recommendations for Repair or Maintenance
Upload Photos (if applicable)
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Inspector Signature
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Rows	Pass	Fail	N/A
Air intake is free from blockages
No signs of pest or animal intrusion
Ducting is properly connected
No visible damage to intake duct