Ministry of the
Solicitor General

OFM - TG-04-1998 attachment 1

OFM-TG-04-1998  ATTACHMENT 1 

(PDF version available on request at AskOFM)

SMOKE ALARM MAINTENANCE CHECKLIST

Address/Suite Number:_____________         Date:    _______________

Smoke alarm has been tested as a result of:


________________ routine test and maintenance
________________ annual test and maintenance
________________ change of tenancy
________________ extended absence of occupants
________________ complaint     ________________
________________ other    _________________

A.

ROUTINE TEST AND MAINTENANCE

YES

NO

(1)

Smoke alarm is securely fastened to the wall or ceiling.

   

   

(2)

Smoke alarm shows no evidence of physical damage, paint application, or excessive grease and dirt accumulations.

   

   

(3)

Ventilation holes on the smoke alarm are clean and free of obstructions.

   

   

(4)

Smoke alarm signal sounds when the test device is operated.

   

   

B.

ANNUAL TEST AND MAINTENANCE

YES

NO

(1)

Smoke alarm is securely fastened to the wall or ceiling.

   

   

(2)

Smoke alarm shows no evidence of physical damage, paint application, or excessive grease and dirt accumulations.

   

   

(3)

Smoke alarm has been vacuumed.

   

   

(4)

Smoke alarm is powered by: __ AC wiring; __ standard battery; __ long life battery that expires in the year _______.
For battery operated smoke alarms:

 

 

 

Battery has been replaced and securely connected to the clips.

   

   

 

Battery is of the type ____________________ as recommended by the manufacturer.

   

   

 

Battery terminals are free of corrosion and signs of leakage.

   

   

(5)

Smoke alarm signal sounds when the smoke alarm is tested using smoke produced from a burning: __ incense stick, __ punk stick, or __ cotton string.

   

   

 C. SERVICING AND REPLACEMENT

(Complete this section if "No" is checked in sections A or B.)

 Smoke alarm has been serviced as follows:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
  

Smoke alarm has been replaced as a result of:
  ______  failure to sound alarm during test
 ______   physical damage
 ______   painted exterior case
 ______   excessive stains, grease or dirt accumulations
______ frequent false alarms
 ______   battery leakage
 ______   age
 ______   other

 ______________________________________________________________________

  

Name and Title (please print):        _______________

Agency (please print):       _______________

Signature:       _______________