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Rock Island Fire Department
Fire Prevention Bureau
2020 Business Self-Fire Inspection Form
Rock Island Fire Department
309.732.2800
marty.greg@rigov.org
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* Indicates required question
Email
*
Your email
Name of person completing self-inspection
*
Your answer
Business Name
*
If this is a multi-family residential building, list name of building.
Your answer
Business Address
*
This is the address of the property you are self-inspecting.
Your answer
Business Email Address
An email address for preferred communication between the fire department and your business.
Your answer
Business Phone number
*
Your answer
Business Owner
*
Name of person who owns the 'business'
Your answer
Business Owner Phone Number
*
Your answer
Building Owner Name
Only answer if different person than business owner.
Your answer
Building Owner Phone Number
Only answer if different person than business owner.
Your answer
Emergency Contact Name
*
This is the person who would respond to your building in an emergency.
Your answer
Emergency Contact Phone Number
*
Your answer
2nd Emergency Contact
Your answer
2nd Emergency Contact Phone Number
Your answer
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