Smoke Detector Inspection Form.2024

Smoke Detector Inspection Form
Inspector Name*

First NameLast Name
Date*

MonthDayYear
Date
Facility*
Enter your address
Reason for Inspection*

Routine test and maintenanceExtended Absence of OccupantsAnnual test and maintenanceComplaintChange of tenancyOther
Click the arrrow below to expand each section. If you have more than 15 smoke detectors in your facility, please enter information in the notes section.

Smoke Detector 1
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 2
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 3
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 4
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 5
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 6
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 7
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 8
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 9
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 10
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 11
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 12
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 13
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 14
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Smoke Detector 15
Location
Example, Upstairs Living Room, Downstairs Bathroom, Bedroom 1, Bedroom 2, etc.

General Inspection (please clearly indicate in the NOTES section any care that is needed for the smoke detector. E.G. - needs replacement, battery, etc.)

	Yes	No	Notes
Smoke alarm is securely fastened to the wall or ceiling.
Smoke alarm shows no evidence of physical damage, paint application or excessive grease and dirt accumulations.
Ventilation holes on the smoke alarm are clean and free of obstructions.
Smoke alarm signal sounds when the test device is operated.

Actions

	Yes	No	Notes
Battery Changed?
Replaced?

Additional Notes & Comments
Date

MonthDayYear
Date
Signature

Clear
Should be Empty: