| Project Address |
|
| General Contractor |
|
DOB Job No. |
|
SSM Name & License # |
|
| CSFSM Name & COF No. |
|
Year |
|
Monthly inspection required per NFPA 10 §7.3. Check: gauge needle in the green zone, pull pin installed with tamper seal intact, nameplate legible, no physical damage to shell or hose. Apply inspection tag. Any deficiency — remove from service and replace immediately. Annual maintenance by a qualified contractor required per NFPA 10 §7.4; record service date in the final column.
| # |
Ext. ID |
Location |
Type / Rating |
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |
Annual Svc. Date |
| 1 | | | | | | | | | | | | | | | | |
| 2 | | | | | | | | | | | | | | | | |
| 3 | | | | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | | | | |
| 11 | | | | | | | | | | | | | | | | |
| 12 | | | | | | | | | | | | | | | | |
| 13 | | | | | | | | | | | | | | | | |
| 14 | | | | | | | | | | | | | | | | |
| 15 | | | | | | | | | | | | | | | | |
| 16 | | | | | | | | | | | | | | | | |
KEY: Enter initials + date for compliant inspection | ✗ = Deficiency found — remove from service | — = Extinguisher not yet deployed to site
| SSM Name (print) | | License No. | |
| SSM Signature | | Date | |
| CSFSM Name (print) | | COF No. | |
| CSFSM Signature | | Date | |