Completion & Deficiency Report

Hood Inspection Support

Use this digital form to document system cleaning and inspection results; any 'No' response indicates a deficiency that must be detailed in the report below and submitted to the local fire authority within 5 business days.

Utah State Fire Marshal

Completion & Deficiency Report

Commercial Kitchen Exhaust System Service

System Location / Owner

Business Name

Address

City, State, Zip

Business Phone

Service Provider Information

Company Name

Technician Name

Date of Service

C&R Reg. #

Exp. Date

24 Hour Emergency Phone

System Inspection

1. Are the filters clean?

Yes No N/A

2. Are the precipitators/pollution control devices clean?

Yes No N/A

3. Is the grease load < 2000 microns?

a.) Horizontal

Yes No

b.) Vertical

Yes No

c.) Hood

Yes No

4. Is the grease load in the fan < 3175 microns?

Yes No N/A

5a. Last service cleaning date?

Last Company Name

5b. Check last Deficiency Report: Has deficiency been cleared?

Yes No

Has AHJ been notified?

Yes No

6a. Is the on-site exhaust system diagram available and accurate?

Yes No

6b. Did you inspect or clean the entire system as specified in diagram?

Yes No

7. Has the Service Label been signed, dated and placed in conspicuous location?

Yes No

8a. Are all filters tightly together and in place?

Yes No

8b. If wash system, is main water valve open?

Yes No N/A

9. Do fans operate?

Yes No

10. Have the exhaust fan louvers been cleaned and checked?

Yes No N/A

11. Were exhaust fan(s) cleaned?

Yes No

12. Have the exhaust fan belts/pulleys been inspected & in good working order?

Questions?

For additional information on the Kitchen Exhaust Cleaning & Inspection Program, contact Russ Sneddon, Deputy State Fire Marshal, 385-434-9609 or [email protected].

Utah State Fire Marshal’s Office

410 West 9800 South, Suite 372
Sandy, Utah 84070

Hours: Monday - Friday, 8:00 am - 5:00 pm

Phone: 801-256-2390
Toll Free: 801-256-2386

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