Revision---A

Code:CTF/MT/02
FIRE CYLENDER NO- ABC-01
CHECK LIST FOR FIRE EXTINGUISHER
Sr. Tick Mark if OK Remarks If
No. Check Points Freq. any
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Visual inspection of Fire
1 W
extinguisher

2 Check working of all Fire M

Extinguisher
Check status of Date of
3 fire extinguisher riffiling M
date

Check working of all fire

4 extinguisher guage M
properly

W= Weekly, M=Monthly

Checked By Verified By
 REVISION---A
CODE:

CHECKLIST FOR WASHROOM FOR THE MONTH OF ______________________________

Point to be Checked
Remarks (Any Check By (Signature
Week A) Cleaniness B) Leakage & Breakage C) Availability of Necessary Goods Other with Corrective
Urinal & Towel & Water Observation) Remarks)
Urinal Toilet Seat Wash Basin Floor Toilet Seat Wash Basin Tap Soap Lighting Dustbin
Pipe's Hanger Pot

1st Week

2nd Week

3rd Week

4th Week

Note: Use Symbol 1) √ Tick for OK 2) X for not OK