HomeMy WebLinkAboutOwner-Occupied Fire & Life Safety Checklist Form
Fire and Life-Safety Checklist Form for Owner-Occupied Units
in Structures Requiring a Rental Permit
To protect the health and safety of all residents, the City of Iowa City Housing Code requires inspections of
owner-occupied dwellings in buildings requiring Rental Permits. Please inspect the items listed below, sign
your name, address and date where indicated to certify these items have been inspected. Return this
checklist form to your property manager. If you would like the City to inspect these items for you, please
notify your property manager who will inform you of the time and date of the City’s inspection.
0 Functioning smoke alarms installed according to manufacturer's instructions on every floor level, in
hallways leading to bedrooms and in all bedrooms. Smoke alarms 10 years old or more need to be
replaced with new UL listed smoke alarms installed to local code and manufacturer's specifications.
0 A fully charged 2A-10BC (minimum size) fire extinguisher mounted in an accessible location. Fire
extinguishers must display a noticeably visible manufacturer’s date either by tag or permanent
marking on the canister. Any fire extinguisher six years old or more must be serviced and properly
tagged by a qualified agency or be replaced with a new, properly mounted 2A-10BC (minimum size)
fire extinguisher.
0 No unapproved extension cords or multi-plug adapters. UL listed “power-strips” with built-in surge
protection are an approved device.
0 All electrical equipment is in good condition and safely maintained.
0 All heating equipment is in good condition and safely maintained.
0 No combustible storage (paper, cardboard, cloth, etc.) within three feet of fuel burning equipment.
0 Plumbing fixtures and piping are in good condition and safely maintained.
0 Required handrails and guardrails are maintained in a safe condition.
SIGNATURE DATE
ADDRESS
PRINT NAME_____________________________________________________________________
Please return this completed checklist to your property manager at your earliest convenience.
*All items on this form must be checked off for unit to be in compliance*
Thank you,
City of Iowa City Housing and Inspection Services (319-356-5130)
hisinsp/fire life safety form (2) 01/08