For Year: _________

MONTHLY FIRE EXTINGUISHER MAINTENANCE LOG

Company Name: GREEN ENVIRONMENTAL MANAGEMENT SYSTEM (GEMS)

Company Address: Bankal Road, Lapu-lapu City, 6015 Cebu, Philippines

Company Telephone Number: 260 4331

Unit Number: ______________ Manufactured Date: _______________

Serial Number: ________________________ Location: _______________________________

TYPE: (check one) ABC Dry Chemical C02

BC Dry Chemical Pressurized Water
K Extinguisher

Recharging Date: ____________________ Hydro Test Due Date: ____________________

Next Annual Inspection Date: ___________________

Next 6-Year Inspection Date: _____________________

*
CONDITION
MONTH DATE REMEDIAL ACTION COMMENTS INITIALS
Pass Fail

January
February
March
April
May
June
July
August
September
October
November
December

VISUAL INSPECTION : Must inspect at approx 30 day interval from the previous month. Document on either this sheet
OR tag on extinguisher
Inspect Points: 1. Located in Designated Place, 2. No Obstruction to Access, 3. Label Faces Outward, Visible & Legible,
4. Safety Pin In Place, 5. Tamper Tag in Place, 6. Gauge in Safe Zone (Green Zone), 7. Lift unit & confirm if it "Feels" Full,
8. Physical Damage;

*
Please see the MONTHLY FIRE EXTINGUISHER SAFETY CHECKLIST

Annual Test Date: _______________________

Approved By: ________________________ Done By: ____________________________