Smoke Detector Inspection Form

Smoke Detector Inspection Form
Inspector Name

First NameLast Name
Location
Month
Inspection Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Routine test and maintenanceAnnual test and maintenanceChirpingOther

Detector Tested and Functioning?

Rows	Yes	No	Notes
Detector 1
Detector 2
Detector 3
Detector 4
Detector 5
Detector 6
Detector 7
Detector 8
Detector 9
Detector 10
Detector 11
Detector 12
Detector 13
Detector 14
Detector 15
Detector 16
Detector 17
Detector 18
Detector 19
Detector 20
Detector 21
Detector 22
Detector 23
Detector 24
Detector 25
Detector 26
Detector 27
Detector 28
Detector 29
Detector 30

General Inspection

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

Actions

Rows	Yes	No	Notes
Battery Changed?
Replaced?

Additional Notes & Comments
Signature

Clear
Should be Empty: