Business Self-Inspection Program, Longmont Fire Department, Longmont, Colorado
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Business Self-Inspection Form

If you have questions or would like to speak to someone directly about this form, please contact the Fire Inspector at (303) 651-8833 or by fax at (303) 774-4682 or email Fire Inspector.


Fields with an asterisk (*) are required.

Business Name *
Business Owner First Name *
Business Owner Last Name *
Address *
City *
State *
  
Zip *
E-mail *
Confirm E-mail *
Telephone *
i.e. 303-776-6050
24-hr Emergency Contact (#1) First Name *
24-hr Emergency Contact (#1) Last Name *
24-hr Emergency Contact (#1) Telephone *
i.e. 303-776-6050
24-hr Emergency Contact (#2) First Name
24-hr Emergency Contact (#2) Last Name
24-hr Emergency Contact (#2) Telephone
i.e. 303-776-6050

Q1. Is building or unit address numbers/letters visible from the street? *
Q2. Is there a minimum 3-foot clearance around the on-site fire hydrant? *
Q3. Do all exit doors remain unlocked during business hours? *
Q4. Are the exit doors operable from the inside without the use of a key or special knowledge? *
Q5. Are illuminated exit signs fully illuminated in the normal and back up modes? Push the test button to determine back up functionality. *
Q6. Do the emergency lighting fixtures work properly? Frog-eyed types: conduct a test by pushing the test button for at least 30 seconds. *
Q7. Are exit aisles, hallways, stairways clear of obstructions? *
Q8. Are combustibles stored in exit corridors, hallways or under stairs? *
Q9. Are all electrical outlets, switches and junction boxes covered with proper cover plates? *
Q10. Are circuit breakers in panels labeled to identify the area protected? *
Q11. Are extension cords in use? Extension cords are not to be used in place of permanent wiring. They may be utilized to supply power to a single small appliance such as a fan, radio or power tool. *
Q12. Are power strips, with a built-in breaker, plugged directly into approved electrical outlets? No power strip on power strip use. *
Q13. Are portable electric space heaters used? If so, they must be plugged directly into wall outlets and operated a minimum of 3 feet away from combustibles. *
Q14. Are combustibles stored in equipment rooms? Combustibles are not to be stored in boiler rooms, mechanical rooms or electrical equipment rooms. *
Q15. Is there at least 18 inches of clearance, free from combustible items, around hot water heaters and furnaces? *
Q16. Is storage of items maintained at least 2 feet below the ceiling? *
Q17. Are ceiling tiles fixed in place? This allows the ceiling to act as a heat collector for fire protection systems and to prevent the passage of smoke and fire. *
Q18. Are there an adequate number of fire extinguishers? There should be no more than a 75-foot travel distance to a fire extinguisher. Extinguishers should be an all purpose ABC Type- minimum U.L. rating of 2A-10B:C. *
Q19. Is the fire extinguisher firmly mounted to a stable structure, visible, accessible and ready for use? Free standing is not acceptable. *
Q20. Has the fire extinguisher(s) been inspected and tagged to indicate a current annual inspection? *
Q21. Are batteries replaced in single station smoke detectors annually? *
Please attach a copy of your current fire alarm and sprinkler inspection reports to this online form using the "Attach Files" buttons below. In lieu of attaching them below, you can also mail in the paper copies of these reports to: LFD Fire Prevention, 225 Kimbark Street, Longmont, CO 80501.
Q22. If there is a fire alarm system, has the system been inspected within the past (12) months by a city licensed contractor? If yes, attach a copy of the inspection report. *
Attachment 1
Q23. If there is a fire sprinkler system, has the system been inspected within the past (12) months by a city licensed contractor? If yes, attach a copy of the inspection report. *
Attachment 2
Q24. Are compressed gas cylinders such as oxygen, acetylene, argon, nitrogen, and nitrous-oxide secured to a fixed structure or on carts to prevent them from falling? If yes, provide the name of the compressed gas and quantity of each. *
Attachment 3
Q25. Do you use or store hazardous materials? If yes, provide a Hazardous Materials Inventory Statement (HMIS) identifying the name of the material(s), physical state (solid, liquid, or gas), CAS (Chemical Abstract Service) number and the quantity of each material. *
Attachment 4
*


If you want a copy of your completed inspection, click the "Print Preview" button prior to the "Submit" button.