Form 17-C 
FIRE AND SMOKE DAMPERS
Inspection and Maintenance
Year
Location
System
Date
Inspector
1. Full unobstructed access to dampers is provided.
2. Smoke damper needs to be cycled through its closure and opening in accordance with NFPA 72.
3. Fusible link, if provided, is removed and damper closes completely and latches closed (where latch provided).
4. No interference with damper operation by rusted, bent, or misaligned parts, damaged blades, or defective hinges.
5. Damper frame not penetrated by foreign objects to prevent proper operation.
6. Fusible link is not damaged or painted. If damaged, it should be replaced.
7. All exposed moving parts to be dry lubricated per manufacturer’s instructions.
8. Note deficiencies and how they were corrected. After any repairs, the damper should be retested for proper operation.
Y = Satisfactory
N = Unsatisfactory (explain below)
Fire Damper Number or Location
1
N/A = Not applicable
2
3
4
5
6
7
Note: Use reverse side for comments.
Note: Dampers must be tested and inspected 1 year after installation and then every 4 years, except in a hospital,
where they can be inspected every 6 years.
8