Smoke Barrier INSP Form

SMOKE BARRIER/DOOR PM’S INSPECTION FORM

FACILITY:

FLOOR:

INSPECTOR:

DATE:

BUILDING:

LOCATION:

SIGNATURE:

COMPLIANT

⃝ YES
⃝ NO

(IF NOT COMPLIANT FILL OUT DESCRIPSTION)

SMOKE BARRIER INSPECTION CHECKLIST

PASS

FAIL

N/A

⃝

⃝

⃝

⃝

⃝

⃝

Visual confirmation that smoke barrier is present.

NOTE:

Adjoining rooms have visible fire barrier.

100% indicates that ONE side of Smoke Barrier is
completely intact with no penetrations

Adjoining room(s) ID
⃝

⃝

⃝

Wing entrances may contain cable tray used for data,
and electrical lines. If this is applicable to the inspected smoke barrier, ensure fire rated pillow is used to
completed smoke barrier.

Identified smoke barrier meets 100% completion
(No through penetration)

SMOKE DOOR INSPECTION CHECKLIST

PASS

FAIL

N/A

⃝

⃝

⃝

Door Present

⃝

⃝

⃝

Door resist passage of smoke
⃝
⃝
⃝
(Gaps are less than ¾” undercut and less than ¼” at jambs and header)

⃝

⃝

⃝

Door lite is has no damage

Door closes properly

DESCRIPTION OF FAILURES:

Repairs Made:

DATE REPAIRS WERE COMPLETED:

REPAIRS COMPLETED BY:

ONCE COMPLETED

ALL INSPECTION FORMS MUST BE RETURNED TO

CARPENTER SHOP SUPERVISOR

FOR VERIFICATION AND UPLOAD