To save as PDF: use your browser's Print → Save as PDF or Print to PDF. This record prints as 2 pages (A4).
Annual / periodic maintenance record: AS 1851 compliant: to be completed by a licensed fire protection technician
PAGE 1 OF 2
Annual Inspection: External Condition
Mark P = Pass | F = Fail | N/A = Not applicable. Record notes for any item marked F.
| # | Check | P | F | N/A |
|---|---|---|---|---|
| External Condition | ||||
| 1 | Cylinder body: no dents, corrosion, bulging or leaks | |||
| 2 | Label / nameplate: legible, agent type and instructions visible | |||
| 3 | Anti-tamper seal: intact and unbroken | |||
| 4 | Pressure gauge: needle in green / charged zone | |||
| 5 | Hose: no cracks, blockage, fraying or damage | |||
| 6 | Horn / nozzle: no blockage, damage or cracking | |||
| 7 | Safety pin: in place, intact, pull-ring not bent | |||
| 8 | Mounting bracket: secure, signage visible and legible | |||
Agent Weight / Volume Check
Notes (external / pressure)
Annual Certification
I certify that I have inspected and serviced the above fire extinguisher in accordance with AS 1851 (Maintenance of fire protection systems and equipment) and applicable standards. The extinguisher has been examined internally (where required), agent weight and pressure checked, recharge completed (where required), tamper seal and service tag renewed, and the unit is in the condition indicated above. Any defective units have been removed from service and tagged accordingly.