Cleaning and Inspection of Smoke Detectors
Performed Every 3 Months
Smoke Detectors
Rows
Tested
Cleaned
New Battery
Date
Initials
Bedroom 1
Yes
No
Yes
No
Yes
No
Bedroom 2
Yes
No
Yes
No
Yes
No
Bedroom 3
Yes
No
Yes
No
Yes
No
Bedroom 4
Yes
No
Yes
No
Yes
No
Living Room
Yes
No
Yes
No
Yes
No
Game Room
Yes
No
Yes
No
Yes
No
Kitchen
Yes
No
Yes
No
Yes
No
Kitchen Carbon
Monoxide Detector
Yes
No
Yes
No
Yes
No
Print Manager Name
First Name
Last Name
Manager Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Print
Submit
Should be Empty: