Fire Safety Audit

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A Fire Safety Audit helps to ensure that proper safety elements are in place for identifying, eliminating, or controlling hazards that could pose a danger to a business and its employees.

To complete the form below, please review each question and check “Yes” or “No”. If a question does not apply, check “N/A”. A “No” answer will indicate a condition requiring attention.

Click here to download a PDF version of this form.

If you have any questions, feel free to contact the Fire Inspector at (231) 724-6792.

Business Name
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
House Keeping
Are spaces, including under stairways and around heating devices kept free of accumulated combustibles?
- Yes
- No
- NA
Are ashtrays emptied into non-combustible containers daily?
- Yes
- No
- NA
Is the outside dumpster kept at least 5 feet away from combustible walls, windows and doors and is the lid kept closed?
- Yes
- No
- NA
Are flammable and combustible liquids like gasoline, oil, etc. stored in approved containers and do not exceed a total of 10 gallons?
- Yes
- No
- NA
Are hazardous materials used, stores, or manufactured on the premises?
- Yes
- No
- NA
If yes please fill out our Hazardous Materials Inventory on our website at https://www.muskegon-mi.gov/fire-department-forms/
Exits
Are exit ways and doors easily recognizable, unobstructed and unlocked during business hours?
- Yes
- No
- NA
Are all illuminated exit signs and/or emergency lighting systems working properly?
- Yes
- No
- NA
Are all automatic closing doors kept unblocked and working properly? Do they close and latch?
- Yes
- No
- NA
Electrical
Electrical panel has a minimum of 30” clearance, all circuits are labeled, and breakers are free from tape or other devices that keep breakers from operating?
- Yes
- No
- NA
Are all electrical covers for outlets, switches and junction boxes in place?
- Yes
- No
- NA
Are all electrical devices properly grounded?
- Yes
- No
- NA
If multi-outlet adapters are used, does the adapter have its own fuse or breaker?
- Yes
- No
- NA
Extension cords are used as temporary wiring only, not in place of permanent wiring and only used for one portable appliance?
- Yes
- No
- NA
Heating
Is your heating equipment in good working order and free of lint and dust accumulation?
- Yes
- No
- NA
Are portable heaters equipped with automatic safety shut-off devices?
- Yes
- No
- NA
If you have a boiler, has it been inspected within the last year, and is the current boiler inspection posted?
- Yes
- No
- NA
Fire Protection
Are fire extinguishers properly mounted, accessible, and inspected by a certified company within the last year?
- Yes
- No
- NA
Are employees familiar with the use of portable fire extinguishers?
- Yes
- No
- NA
Do all apartment units have smoke detection? Are they checked periodically?
- Yes
- No
- NA
Cooking ventilation hood fire suppression system has been inspected and tagged by a certified company within the last six months?
- Yes
- No
- NA
Date of Inspection
MM slash DD slash YYYY
Inspected by
Does your commercial kitchen contain a class K fire extinguisher?
- Yes
- No
- NA
Miscellaneous
All holes in walls and ceilings are patched; ceiling tiles are in place and in good condition?
- Yes
- No
- NA
All compressed gas cylinders are secured to prevent falling?
- Yes
- No
- NA
Is the gas meter, regulator, or exposed piping protected from vehicular traffic?
- Yes
- No
- NA
Is address visible, legible, of a contrasting color, and permanently posted on building?
- Yes
- No
- NA
Does your business contain a Fire Department Access Entry Key Box? If not, contact the Fire Department for Keybox Order Form. Home businesses are exempt.
- Yes
- No
- NA
Do you have an automatic external defibrillator (AED) on site?
- Yes
- No
- NA
If yes, where is it located?
Location
Name
First Last
Signature
Date
MM slash DD slash YYYY
Additional Comments:
Thank you for your cooperation and concern for others as well as your own fire safety.
EMERGENCY CONTACT FORM
Information on this form is for official use only
BUSINESS NAME:
BUSINESS ADDRESS
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Must Have Three Contacts
PRIMARY EMERGENCY CONTACT PERSON (During & AFTER Hours):
Name
First Last
Title
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Work Phone
Other Phone
SECONDARY EMERGENCY CONTACT PERSON (During & AFTER Hours):
Name
First Last
Title
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Cell Phone
Other Phone
CONTINGENT EMERGENCY CONTACT PERSON (During & AFTER Hours):
Name
First Last
Title
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Cell Phone
Other Phone

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West Michigan's Shoreline City

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Muskegon City Hall
933 Terrace St,
Muskegon, MI 49440-1397

(231) 724-6705

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Friday, Saturday, Sunday: Closed

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Fire Safety Audit

House Keeping

Exits

Electrical

Heating

Fire Protection

Miscellaneous

EMERGENCY CONTACT FORM

Must Have Three Contacts

PRIMARY EMERGENCY CONTACT PERSON (During & AFTER Hours):

SECONDARY EMERGENCY CONTACT PERSON (During & AFTER Hours):

CONTINGENT EMERGENCY CONTACT PERSON (During & AFTER Hours):

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