Wildfires: Information and Community Resources


Self-Fire Inspection Form

Self-Fire Inspection Form

Instructions:  Fill in all the information on the form.  Walk through your occupancy to ensure the safety requirements on the checklist are fulfilled.  If an item is compliant, check the "Yes" box.  If an item is non-compliant, either remedy the problem before submitting this form or check the "No" box and we will follow up ensuring the hazard is corrected.  If an item does not apply, check the "N/A" box.  Any hazard not addressed in the questions can be typed into the "Additional Comments" box. Click on the "View Informational Slides" link for each section if you need additional code information.

When completed, click on the "Submit" button to automatically E-mail your form to the Medford Fire-Rescue Fire & Life Safety Division. Thank you for participating!

Occupancy Information
Emergency Contact Names & Phone Numbers
(After-hours Responsible Parties to be contacted by Dispatch if necessary)
Access & Premises

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* Is the exterior fire department access road unobstructed?
* Is there maintained a minimum 3' clearance around fire hydrants?
* Are address numbers for the building clearly visible from the street?
* Is combustible vegetation removed so as to not create a fire hazard?
Egress Requirements

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* Are doors with self-closing hinges maintained in the closed position (not blocked open)?
* Are the exitways and doors easily recognizable, unobstructed, and maintained functional?
* If the main exit door is provided with key-locking hardware as allowed by code, is there a sign above the door that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED" and are the other exit doors openable from the inside without the use of a key or any special knowledge or effort?
* Are the other required exit doors readily openable from the inside without the use of a key or special knowledge or effort?
* Are the exits and exit enclosures free from the storage of combustible materials?
* Is the means of egress illuminated when the building or structure is occupied?
* In residential occupancies, are emergency escape or rescue windows, doors or window wells required by the Building Code for sleeping rooms maintained openable and free from any obstruction that would inhibit the occupant from escaping?
* Are all electrical outlets, switches and junction boxes properly covered with cover plates and is the electrical system safe from any apparent shock and/or other electrical hazards?
* Are circuit breakers/fuses labeled so as to identify the area protected?
* Is the area maintained clear at least 30" in front of electrical panel(s)?
* Are extension cord(s) of heavy duty construction, maintained in good condition, and only used as temporary wiring, or to service small portable appliances?
* Are extension cord(s) grounded when serving grounded appliances?
* Are extension cord(s) plugged directly into an approved outlet, power tap or multi-plug adapter and, except for approved multi-plug extension cord(s), serve only 1 portable appliance?
* Is the ampacity of the extension cord(s) greater than the rated capacity of the portable appliance supplied by the cord(s)?
* Are extension cords used only for temporary use?
* If multiple items need to be plugged in, is a power tap utilized with a built-in circuit breaker and is the power tap plugged directly into a permanently installed receptacle?
Emergency Lighting/Egress Illumination

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* If emergency lighting is provided, is it maintained in operable condition?
* If exit signs are required, are they maintained illuminated or self-luminous?
* Does the backup-battery work (push the test button and the exit sign should illuminate under battery power)?
Fire Alarm System

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* If the building is equipped with a fire alarm system, has the required annual service of the fire alarm system been performed by a qualified fire alarm company?
Fire Extinguishers

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* Is there access to fire extinguisher(s) rated at a minimum 2A-10BC?
* Have the fire extinguisher(s) been serviced and tagged by a fire extinguisher company within the last 12 months?
* Is the travel distance from all portions of the building less than 75’ to a fire extinguisher?
* Are all fire extinguishers visible and accessible (not blocked)?
* Are the fire extinguisher(s) properly mounted?
(Proper locations-near exit doors where possible, not exceeding maximum travel distance, properly mounted (maximum 5’ high if <40 lbs., maximum 3 ½’ high if >40 lbs. In all cases, minimum 4” above the ground).
Fire Safety & Evacuation Plans

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* If required, are Evacuation Plans posted?
* If required, do you have Fire Safety Plans?
* If fire drills are required, are they conducted successfully at varying times and under varying conditions and are records maintained on the premises?
Fire/Smoke Separations

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* Are the fire/smoke separations (automatic smoke doors, fire doors, etc.) maintained and in working condition?
Fire Suppression Systems

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* If the building is equipped with a fire sprinkler system, has the required annual service of the fire sprinkler system been performed in the last year by a qualified sprinkler company?
* Is the top of storage maintained a minimum 18” below head deflectors in fire sprinklered areas?
* In commercial cooking applications, has the hood suppression system been serviced in the last six months and is the hood cleaned at intervals to prevent the accumulation of grease?
Heat Producing Appliances

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* If portable electric heaters are used, are they used safely? Also, are they plugged directly into wall outlets and kept a minimum of 3' away from combustibles?
(Open flame unvented heaters are prohibited for use in a commercial occupancy).
* Is the clearance between ignition sources, such as light fixtures, heaters, and flame producing devices, and combustible storage maintained in an approved manner?
Housekeeping & Decorations

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* Is combustible rubbish that is stored in containers outside of vaults or rooms removed from the building a minimum of once each working day?
* Are oily rags or similar materials stored in metal, metal-lined or other approved containers equipped with tight-fitting covers?
* Are combustible decorations flame retardant?
Mechanical Hazards

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* Is the venting for exhaust products of combustion in tact for gas appliances (like water heaters, furnaces, etc.)?
* Are safe clearances maintained between gas fired appliances (such as water heaters, furnaces, etc.) and combustible materials?
* In rental houses, apartments, lodging houses and hotels, are smoke detector(s) installed either hard-wired with a “hush” feature or 10 year battery powered with a “hush” feature (ionization detectors only, addressable fire alarm systems exempt) ORS 479.255
* If smoke detection is required in common areas such as corridors or part of the fire alarm system, have they been tested in the last year by a qualified service company?
Storage of Combustibles

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* Is the storage of combustible materials orderly?
* Are combustible materials not stored beneath the building or structure?
* Are the boiler rooms, mechanical rooms and electrical panel rooms maintained without the storage of any combustible materials within?
* Are rubbish containers over 5 1/3 cubic feet (40 gallons) provided with lids and made of noncombustible construction?
* Are dumpsters that are 1.5 cubic yards or more not stored inside the building and placed more than 5’ from combustible walls, openings or combustible roof eave lines?
Storage, Compressed Gas Cylinders

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* If you have compressed gas containers (such as co2, helium, etc.), are they chained to prevent falling?
Storage of Flammable and Combustible Liquids

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* Are quantities in excess of 10 gallons of flammable and combustible liquids used for maintenance purposes and the operation of equipment stored in liquid storage cabinets?
Storage of Hazardous Materials

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* If you have quantities of hazardous materials exceeding the amounts listed in the "View Informational Slides" above, have you completed the State of Oregon Hazardous Information Survey?

The list of items on the Self-Fire Inspection Form is intended to cover the most common items/hazards we encounter while performing fire inspections in low hazard occupancies.  It is not intended to be all comprehensive or replace specific code requirements not addressed on the form.  If you have a specific code related question not addressed on this form, please call Medford Fire-Rescue's Fire & Life Safety Division at 774-2300.

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