Pike Township Fire Department

4881 West 71st Street
Indianapolis, Indiana 46254
317-347-5860


The Fire Department wishes to thank you for taking the time to conduct a self fire inspection. Your dedication to the safety of your employees and to the community is to be commended. We look forward to partnering with you in these efforts. You may print this screen off and inspect your business. Then enter the inspection information online.

You may also fill the business information section out to keep your emergency contact information up to date in our files.

Business Information

Business Name
Phone( ) -
Address Number Street Name Suite
City State Zip
Email Address
Fax ( ) -


Property Owner Information

First Name Last Name
Phone Number ( ) -
Address Number Street Name Suite
City State Zip


Emergency Contact Information

First Name Last Name
Phone Number #1 ( ) -     Phone Number #2 ( ) -

First Name Last Name
Phone Number #1 ( ) -     Phone Number #2 ( ) -

Fire Alarm Monitoring Company
Phone Number #1 ( ) -


Person Submitting the Form

First Name Last Name
Phone Number ( ) -


Self Fire Inspection

Outside

1. Is your address visible from the street? Yes No
If 'No' - explain

2. Is your gas meter protected from vehicle damage? Yes No N/A
If 'No' - explain

3. Does your business utilize a fire department key box and keys up to date? Yes No
If 'No' - explain

4.If you have a fire sprinkler system is your fire department connection accessible to the fire department? Yes No N/A
If 'No' - explain

Exits

1. All lighted exit signs have working light bulbs?		 Yes No
If 'No' - explain

2. All emergency lights operational? Yes No
If 'No' - explain

3. All exit doors unobstructed and easily accessible? Yes No
If 'No' - explain

4. All exit doors have no sliding dead bolts? Yes No
If 'No' - explain

Fire Protection Systems

1. Does your building have a fire sprinkler system?		 Yes No
If yes, has the system been inspected and tested in the last 12 months?
 Yes No
If 'No' - explain

2. Does your building have a fire alarm system? Yes No
If yes, has the system been inspected and tested in the last 12 months?
 Yes No
If 'No' - explain

3. Does your building have a cooking hood fire suppression system? Yes No
If yes, has the system been inspected and tested in the last 6 months?
 Yes No
If 'No' - explain

4.Does your building have a cooking exhaust hood system? Yes No
If yes, has the system been inspected and cleaned in the last 6 months?
 Yes No
If 'No' - explain

5. Does your building have other automatic fire suppression systems? Yes No
If 'Yes' - explain

6. Does your building have fire extinguishers that have been inspected within the last 12 months? Yes No
If 'No' - explain

7. Are your fire extinguisher mounted? Yes No
If 'No' - explain

Electrical

1. Is your business free of extension cords? (Extension cords are not permitted to use as permanent wiring. An example would be that they are not permitted to power an office computer at a desk)		 Yes No
If 'No' - explain

2. Is the building free from multiplug adapters such as cube adaptors and unfused plug strips? Yes No
If 'No' - explain

3. Are your electrical power strips (power taps) individually plugged into a wall receptacle and not chained together? Yes No N/A
If 'No' - explain

4. Are all electrical outlets, switches and junction boxes properly covered with cover plates? Yes No
If 'No' - explain

5. Is the buildings free from any exposed wiring and do all electrical junction boxes have protective covers? Yes No
If 'No' - explain

6. Is there a clear path to electrical panels with clearance in front of them? Yes No
If 'No' - explain

Inside building requirements

1. Is the storage in the building at least 2 feet from the ceiling or 18 inches below the sprinkler heads?		 Yes No
If 'No' - explain

2. Is your storage neat, orderly, and separate from heaters or heating devices? Yes No
If 'No' - explain

3. Are all rated fire doors closed? Yes No
If 'No' - explain

4. Are all walls and ceilings being maintained and not damaged? Yes No
If 'No' - explain

5. Are your compressed gas containers (such as CO2, helium, etc.), chained to prevent falling? Yes No N/A
If 'No' - explain

Hazardous Materials

1. Are MSDS (material safety data sheets) for chemicals up to date and readily available?		 Yes No N/A
If 'No' - explain

2. Are visible hazard identification signs posted (example: NFPA 704) at stationary containers, above ground tanks and at entrances to locations where hazardous materials are stored? Yes No N/A
If 'No' - explain

3. Are chemicals that are incompatible stored away from each other? Yes No N/A
If 'No' - explain

4. Are all flammable liquids that are kept inside buildings stored in proper storage containers or cabinets? Yes No N/A
If 'No' - explain

5. Are bulk drums and tanks of flammable liquids grounded and bonded to containers during dispensing? Yes No N/A
If 'No' - explain

Building Information

1. How many stories tall is your building?



2. Does you building have a basement? Yes No

3. Does your building have confine spaces? Yes No

Request Additional Information (Check all that applies)

You are requesting a follow up phone call on this inspection.
You are requesting information on a fire department key box program.
You are requesting public safety fire information.


Additional Comments


By submitting this information you hereby affirm that the information provided in this self fire inspection is true, accurate and complete. I understand that any false statements made herein may violate local laws.