Form Center

2. 

4. The Portland Fire Department Corrective Action Plan (CAP) form must be completed when a deficiency is identified during a fire safety inspection, in lieu of a re-inspection by the Portland Fire Department. Failure to submit and implement a corrective action plan may result in penalties as provided by law. The submitted form will be kept on file with the Portland Fire Marshal’s Office.

   IMPORTANT: This form must be completed by a person with executive authority who can ensure the corrections listed are completed. By submitting this form, you certify that appropriate steps are being taken within a reasonable timeframe to correct all deficiencies identified in the inspection report and to ensure the safety of all occupants. Unless deemed necessary, the Portland Fire Department will not conduct immediate follow-up inspections for the deficiencies reported.

8. Business Name*
10. Business Address*
12. City*
13. State*
14. Zip Code*
16. First Name*
17. Last Name*
19. Business Title*
20. Today's Date*
    Today's Date

    Today's Date
22. Phone Number*
23. Email Address*
25. List below all deficiencies noted on your business's Company Inspection Report issued by the Portland Fire Department.*
27. Answer below a plan to correct the deficiencies listed on the inspection report.*
29. Do you agree to correct all deficiencies in a reasonable amount of time?*
    -- Select One --Yes, I agree.No, I refuse to correct the issues.
30. What is the anticipated completion date of the corrective actions listed?*
    What is the anticipated completion date of the corrective actions listed?
32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field