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GLOS Fire, Safety and Health Code Inspection

Please make sure to complete all sections of the form; enter N/A in any blank comments section.

Organization:

Location:

Term:

Date of Inspection (DD/MM/YYYY):

Time of Inspection:
AM PM

Sprinkler Inspection Test:
Dartmouth College
Sprinkler Systems Inc.
Test Date (DD/MM/YYYY):

Sprinkler Inspection:
Dartmouth College
Sprinkler Systems Inc.
Inspection Date (DD/MM/YYYY):

Sprinkler System Condition:
Pass
Fail
Comments:

Emergency Lighting Status:
Pass
Fail
Comments:

Exit Sign Status:
Pass
Fail
Comments:

Means of Egress Status (Stairwells, Hallways, Fire Escapes, etc.):
Pass
Fail
Comments:

Fines:
Pass
Fail
Comments:

Overall Comments:

ALL WORK REQUIRED ABOVE MUST BE COMPLETED WITHIN 2 WEEKS OF THE RECEIPT OF THIS REPORT TO AVOID A $200 PER WEEK FINE.

Inspection completed by:

Report Submission

Please click on the "Submit Report" button to send the report. You will be redirected to a webpage confirming that you have successfully submitted the GLOS Fire, Health and Safety Inspection. If you are not redirected, the form was not successfully submitted.

Last Updated: 10/28/14