MUSCATINE FIRE DEPARTMENT
FIRE PREVENTION BUREAU

Date:*

Business*

Address*

Phone*

Buisness Owner*

Phone*

Alt Phone

Building Owner*

Phone*

Alt Phone

Emergency Contact*

Phone*

Alt Phone

Is the building sprinkled?*

yes no

Standpipe location

Knox box location

Fire Dept connection location

ADDRESS AND PREMISES:
Is the address visible from the street? Numbers shall be minimum of 4 inches.
Combustible materials and/or vegetation removed from around the building?

Address*

yes no n/a

Combustible materials*

yes no n/a

Vegetation*

yes no n/a

EGRESS (EXITING):
Are the exit ways and door easily recognizable, unobstructed, maintained, functional, and not used as an area of storage?
Can all exit doors be opened from the inside without the use of a key or any special knowledge or effort?
Are exits marked and properly illuminated?
If you have emergency lighting, does it work?

Exit ways/doors*

yes no n/a

Opening*

yes no n/a

Marked*

yes no n/a

Lighting*

yes no n/a

FIRE PROTECTION:
Is there an automatic fire sprinkler system, has it been certified every 5 years and tested quarterly?
are fire walls, draft spots and ceilings free from holes and openings?

Sprinkler system*

yes no n/a

Fire walls*

yes no n/a

FIRE EXTINGUISHERS:
Is the fire extinguisher in a visible and accessible location? it should be mounted so the handle is 3-5 feet from the floor.
Is the fire extinguisher classification 2a10bc or higher?
Is there at least one fire extinguisher within 75' travel distance from anywhere in the buisness?
Have the fire extinguishers been serviced and tagged by a fire extinguisher company within the last 12 months?

Visible*

yes no n/a

Class*

yes no na

Distance*

yes no n/a

Serviced*

yes no n/a

EXIT SIGNS:
If exit signs are required, are they illuminated?
Does the backup battery work? (Push the test button, the exit sign should illuminate under battery power)

Illuminated*

yes no n/a

Battery*

yes no n/a

EMERGENCY LIGHTING:
If emergency lighting is provided, is it maintained in operable condition?

Operation*

yes no n/a

ELECTRICAL:
Are all electrical outlets, switches, and junction boxes properly covered with cover plates?
Are circuit breakers/fuses labled to identify the area protected?
Is the area maintained clear at least 30 inches in front of electrical panel?
Are extension cords being used for temporary wiring?
Are the surge protectors plugged directly into an outlet?

Covered*

yes no n/a

Labeled*

yes no n/a

Clearence*

yes no n/a

Ext Cord*

yes no n/a

Surge Protectors*

yes no n/a

MAITENANCE AND STORAGE:
Are areas outside and around the building free of weeds, debris, and trash?

Outside area*

yes no n/a

HAZARDOUS MATERIALS;
Are the combustible or flammable liquids properly stored on site? (Less than 10 gallons must be in approved containers/Greater than 10 gallons must be in a flammable liquid cabinet)
Are compressed gas cylinders secured so they will not be knocked over or fall?
Are propane containers stored outside?
Are combustible materials stored beneath the stairs?

Stored Properly*

yes no n/a

Cylinders*

yes no n/a

Propane*

yes no n/a

Stairs*

yes no n/a

If you have any questions, please call the Muscatine Fire Department at 563.263.9233