Ventilation Fan Intake Inspection Form
Document the condition and status of ventilation fan intake points during inspection.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Fan Intake
*
Fan Intake ID or Reference
*
Visual Condition of Intake
*
Excellent
Good
Fair
Poor
Obstructions Present?
*
No
Yes
Cleanliness of Intake Area
*
Clean
Dust Present
Debris Present
Requires Cleaning
Operational Status of Fan
*
Operational
Not Operational
Intermittent
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