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<br />Issue <br />Date <br /> <br />Elk River Fire Department <br />415 Jackson Avenue <br />Elk River, MN 55330 <br /> <br />Self Inspection Report <br /> <br />e <br /> <br />Business Name <br /> <br />Street AddresslNumber <br /> <br />Business Telephone <br /> <br />Principle Business Activity <br /> <br />Responsible Party <br /> <br />Responsible Party Telephone <br />(for Emergency Contact) <br /> <br />Directions <br /> <br />1. Walk through your business with this form in hand. Please answer all questions listed below. <br />2. You have until to complete this form. If you need assistance, check the box below or call 441-4919. <br />3. When inspection is completed and corrections made, sign and date the form below. <br />4. Enclose the white copy of this form in the mailing envelope which has been provided. Keep the yellow copy for your records. <br /> <br />YES NO <br /> <br />Not <br />Applicable <br /> <br />1. a. Are the address numbers facing the street of address? <br />b. Are they visible and legible from the roadway? <br /> <br />2. Does your building have fire lanes, and if so, are they kept accessible and unblocked? <br /> <br />3. Are all exit doors kept unlocked and open able from the inside during business hours? <br />Remind customers no parking within 10ft. of any exit door. Recommend sign on outside of door <br />(EXIT DOOR, NO PARKING WITHIN 10 Fl). <br /> <br />Are all appliance cords in good condition? <br />(Insulation not frayed or broke) <br />Are extension cords used for permanent wiring? If so, please remove immediately. <br />Is there 30. clear access to electrical control panel? <br /> <br />7. Is combustible material kept a minimum of 5 ft. away from water heaters, furnaces or boilers? <br /> <br />5. a. <br /> b. <br /> c. <br /> d. <br />6. a. <br /> b. <br /> c. <br /> <br />4. Are illuminated exit signs in working order? <br /> <br />Are fire extinguishers hung on the wall with top not over 5 ft. above floor? <br />Are fire extinguishers checked at regular intervals & serviced annually <br />by a licensed company? <br />Indicate last inspection date <br />Are your employees instructed in location and proper use of fire extinguisher? <br /> <br />e <br /> <br />8. Are shut off valves within 36" of all gas appliances? <br /> <br />9. a. Is waste paper and trash kept in non combustible containers? <br />b. Are combustible or flammable material awaiting collection outside at least 10 ft. from combustible wall. <br />window or door opening of building? <br /> <br />10. a. Are smoke detectors installed on every level? <br />b. Are heat detectors installed in garages & furnace rooms? <br /> <br />11. Is a Fire Department lock box present? <br /> <br />12. Are exits, aisles and corridors free of obstructions? 36" minimum width is reqUIred. <br /> <br />13. Is there combustible storage in unprotected attics or under unprotected stairways? <br /> <br />THANK YOU FOR YOUR COOPSfATION <br /> <br />o Check this box if you need Fire Prevention assistance or call 441-4919. tit <br /> <br />Responsible Party Signature <br /> <br />Date <br /> <br />RETURN WHITE TO FIRE DEPT. . RETAIN YEllOW FOR YOUR RECORDS <br />