Fire Extinguisher Assessment/Replacement Request

Submit this form if you need a fire extinguisher in or near your workspace replaced, refilled, or inspected for any other issues.

Name Name First Last
Department
Email
Phone Phone - ### - ### ####
Request Details
Reason for Inspection

Reason for Inspection Extinguisher was used Extinguisher is expired Different kind of extinguisher is needed Extinguisher is missing Hanging mount is broken/damaged Hanging cabinet is broken/damaged General assessment Other Other
Location Details
Campus/Site
Specify Campus/Site
Building Name
Building Floor
Must be a number between 1 and 20
List the floor if extinguisher is outside, or in a general building corridor, in which a room number is not available.
Room Number
Additional Location Details

Please provide precise extinguisher location details here (i.e. next to restroom; southwest corner of garage; first extinguisher to the right when entering the room; etc.)
Photo of Extinguisher/Location

Attach Files

If possible, please attach a photo of the extinguisher, mount/cabinet, or area where it should be located.

By adding a photo, a technician can better understand the type/size of extinguisher to replace, or type of mount needed, prior to going to the location. This will help expedite the process.
Confirmation

Confirmation A confirmation of this request will be automatically sent to your inbox from MACHFORM after clicking "Submit" below; if you do not see it in your inbox, please check your Clutter or Junk folder, as it is common for the message to end up there. Please acknowledge this message by clicking the checkbox.