Annual Fire Door Inspection Form – Fill Out and Use This PDF

Fill in the Name of Facility, the Fire Door Assembly Location, the Special Locking Arrangement, the Number of Leafs, the Fire Rating of Each Leaf, the Fire Rating of Frame, the Rating of Barrier, the Purpose of Rated Barrier, the Automatic or Manual Operator and the Hold-open Device.

Fill in Inspected By and Date. Fill in Supervisor's Initial and Date; all “No” answers must be fully explained.

Inspection Activity: Yes, No or N/A, and Comments.

1. Is the door and frame free from holes and breaks in all surfaces?

2. Are all the glazing, vision light frames and glazing beads intact and securely fastened?

3. Are the doors, hinges, frame, hardware and threshold secure, aligned and in working order with no visible signs of damage?

4. Are there any missing or broken parts?

5. Is the clearance from the door edge to the frame no more than 1/8 inch?

6. Is the door undercut no more than ¾ inch?

7. Does the active door leaf completely closes when operated from the full open position?

8. Does the inactive leaf close before the active leaf when a coordinator is used?

9. Does the latching hardware operate and secure the door in the closed position?

10. Is the door assembly free from are auxiliary hardware items which could interfere with its operation?

11. Has the door been modified since it was originally installed?

12. If gasketing and edge seals are installed, have they been verified for integrity and operation?

All “No” answers must be fully explained. Fill in Supervisor's Initial, Date and Work Order #.