02 Inspection-Testing and Maintenance Report 2-23-22_Redacted.pdf

Tested to NFPA 72 Standards

This Inspection was performed in accordance with applicable NFPA Standards. The subsequent pages of this report provide performance measurements, listed ranges of acceptable results, and complete documentation of the inspection. Whenever discrepancies exist between acceptable performance standards and actual test results, notes and/or recommended solutions have been proposed or provided for immediate review and approval.

Inspection, Testing, & Maintenance Report

INSPECTION, TESTING, & MAINTENANCE OF FIRE ALARM SYSTEMS

Required Inspection Frequency:

Information on this form covers the minimum requirements of the current edition of NFPA 72 (unless otherwise directed by the authority having jurisdiction).

For

FA.72.19.B.000

Name:

Phone Number:

Account Number:

Manufacturer: Circuit Style:

Model:

Panel/Node: # of NAC Circuits (If Applicable):

Software Rev: # of Zones (If Applicable):

Type of Communicator:

Nominal Input Voltage:

Amp Rating:

Location of Panelboard:

Location of Generator:

Location of fuel Storage:

Fuel Type:

Eq Equip Powered by ESS:

Location of ESS:

Type:

Nominal Voltage:

Amp Rating:

Information on this form covers the minimum requirements of the current edition of NFPA 72 (unless otherwise directed by the authority having jurisdiction).

Name:

System ID: Property Address:

System Location: City:

Periodicity:

Service Tech: State:

Tech Cert/License: Zip:

Special Hazards and Procedures to be Aware of Prior to Testing

INSPECTION, TESTING, & MAINTENANCE OF FIRE ALARM SYSTEMS

ST Job ID: Date:

Property's Contact: Property Name:

Engine-Driven Generator Information

Overcurrent Amp Rating:

Energy Storage Systems (ESS) Information

# of SLC Circuits (If Applicable):

Minutes of Operation in Alarm Mode:

Location:

Monitoring Entity Approving Agency

Phone Number:

Control Unit Information

Primary Power Supply Information

Overcurrent Protection Type:

Hours of Operation in Standby Mode:

Hours of Operation in Standby Mode:

Minutes of Operation in Alarm Mode:

Fuse ID or Breaker #:

Secondary Power Supply Information

INSPECTION, TESTING, & MAINTENANCE OF FIRE ALARM SYSTEMS

ST Job ID: Date:

PART I - OWNER'S SECTION

A. Is the building occupied?

B. Has the occupancy classification and hazard of contents remained the same since the last inspection?

C. Are all fire protection systems in service?

D. Has the system remained in service without modification since the last inspection?

E. Was the system free of actuations of devices or alarms since the last inspection?

PART I - INSPECTION AND TESTING

1. ANNUAL

A. Control Panel & Power Supplies:

1. Control unit and power supplies are free of physical damage?

2. All lamps, LEDs, and/or LCDs are functional?

3. All fuses are functional?

4. All disconnect switches and buttons are functional?

5. Ground-fault monitoring is functional?

6. Circuits properly monitored for integrity (Class A or Class B)?

B. Batteries:

1. All batteries are marked with the month and year of manufacture?

2. All batteries are within equipment manufacturer's replace date?

3. All connections to batteries are tight?

4. All terminals are free of corrosion?

5. All batteries are free of distortion, cracks, and leakage?

6. All batteries test with at least 80% load capacity?

7. All batteries are charging within manufacturer's guidelines?

C. Local & Remote Annunciators:

1. All annunciators pass visual inspection?

2. All annunciators pass functional test?

D. Supervisory Devices:

1. All devices pass visual inspection?

2. All devices pass functional test?

E. Initiating Devices:

1. All devices pass visual inspection?

2. All devices pass functional test?

F. Notification Devices:

1. All devices pass visual inspection?

2. All devices pass functional test?

G. Interface Equipment:

1. All equipment passes visual inspection?

2. All equipment passes functional test?

H. Elevators:

1. Primary recall for all cars operates as designed?

2. Secondary recall for all cars operates as designed?

3. Shunt for all cars operates as designed?

4. Fire hat for all cars operates as designed?

I. Supervising Station Monitoring:

1. Alarm signal received by monitoring within 90 seconds? Record signal time (seconds):

2. Trouble signal received by monitoring within 90 seconds? Record signal time (seconds):

3. Supervisory signal received by monitoring within 90 seconds? Record signal time (seconds):

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES, NO, N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

INSPECTION, TESTING, & MAINTENANCE OF FIRE ALARM SYSTEMS

PART II - NOTIFICATIONS THAT TESTING IS COMPLETE

A. Entities Notified:

1. Monitoring Organization Contact: Record time of day:

2. Building Management Contact: Record time of day:

3. Building Occupants Contact: Record time of day:

4. Authority Having Jurisdiction Contact: Record time of day:

5. Other, if required Contact: Record time of day:

PART III - SYSTEM RESTORAL

A. Date system was restored to normal: Record date:

B. Time system was restored to normal: Record time of day:

Print: Print:

WRITE IN

Technician Customer/Facility Representative:

Sign: Sign:

System Components Passed

Deficiencies Recorded

System Components Tested

COMMENTS - Explain all no answers/deficiencies:

TESTING RESULT SUMMARY

Ion Detector

Photo Detector

Duct Detector

ID = Ionization Detector PD = Photo Electric Detector DSD = Duct Smoke Detector

DETECTOR SENSITIVITY TEST REPORT

ST Job ID: Date:

Property's Contact: Property Name:

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

Periodicity:

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

Device Type Abbreviations:

ID Comments

Pass/Fail or

Not TestedLocation Description

Device

Type

Listed

Sensitivity

Tested

Sensitivity

NOT APPLICABLE

Duct Detector

DSD = Duct Smoke Detector

System ID: Property Address:

System Location: City:

DUCT DETECTOR DIFFERENTIAL PRESSURE TEST REPORT

ST Job ID: Date:

Property's Contact: Property Name:

Periodicity:

CURRENT INSPECTION COUNTS

Quantity Installed

Quantity Tested

Quantity Not Tested

Quantity Passed

Quantity Failed

Service Tech: State:

Tech Cert/License: Zip:

Device Type Abbreviations:

ID Location Description

Device

Type

Pressure

Range

Differential

Pressure Comments

Pass/Fail or

Not Tested

Amps

Panel Make &

Model

Address & Equipment

Location

Breaker Panel

Location

Rating

AmpHr Charger Test

Battery 2

Install Date

(MM/YY)

Pass /

Fail

Load Discharge

Volts

Load Discharge

VoltsVolts Amps Volts

Battery 1

Periodicity:

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

BATTERY REPORT

ST Job ID: Date:

Property's Contact: Property Name:

System ID: Property Address:

System Location: City:

ELEVATOR LIST

ST Job ID: Date:

Property's Contact: Property Name:

Car ID

Periodicity:

Service Tech: State:

Tech Cert/License: Zip:

Fire Hat

Pass/Fail Date

Secondary

Recall

Pass/Fail

Floor for

Primary

Recall

Shunt

Pass/Fail

Primary

Recall

Pass/Fail

Floor for

Secondary

Recall

Number of

Floors/

StopsLocation Description

System ID: Property Address:

System Location: City:

Device Change List ST Job ID: Date:

Property's Contact: Property Name:

Periodicity:

Added or

Removed

Address or

Barcode Device Type Device Location or Explanation of Change

Service Tech: State:

Tech Cert/License: Zip:

Manual Pull Station

Ion Detector

Photo Detector

Duct Detector

Heat Detector

Gas Detector

Beam Detector

Flame Detector

Air Sampling Device

Water Flow

PD = Photo Electric Detector DSD = Duct Smoke Detector BSD = Beam Smoke Detector FD = Flame Detector

ID = Ionization Detector MS = Manual Fire Boxes GD = Gas Detector WF = Water Flow

HD = Heat Detector H-MS = Halon Manual Station HSSD = Air Sampling

DateID

Device

Type CommentsLocation Description

Pass/Fail or

Not Tested

Device Type Abbreviations:

Service Tech: State:

Tech Cert/License: Zip:

Periodicity:

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

System ID: Property Address:

System Location: City:

INITIATING DEVICE LIST

ST Job ID: Date:

Bells

Horns

Chimes

Speakers

Strobes

Horn Strobes

Chime Strobes

Speaker Strobes

Door Holders

H = Horn B = Bell

S = Strobe SPK = Speaker

CH = Chime CS = Chime Strobe

HS = Horn Strobe

SS = Speaker Strobe

DH = Electromagnetic Door Hold

DateID Location Description

Device

Type

Pass/Fail or

Not Tested Comments

Device Type Abbreviations:

Periodicity:

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

NOTIFICATION & OUTPUT DEVICE LIST

ST Job ID: Date:

Site Water Level

Site Water Temperature

Room Temperature

Pressure Switches

Fire Pump Run

Pump Power Loss

Pump Phase Reversal

Abort Switch

Tamper Switch

Monitored Point

FPR = Fire Pump Run AS = Abort Switch SWL = Site Water Level RT = Room Temp.

PPL = Pump Power Loss PS = Pressure Switch SWT = Site Water Temp.

PPR = Pump Phase Reversal TS = Tamper Switch MON = Monitored Point (Specify in Comments)

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

SUPERVISORY SIGNAL LIST

ST Job ID: Date:

Property's Contact: Property Name:

System ID: Property Address:

System Location: City:

Periodicity:

Service Tech: State:

Tech Cert/License: Zip:

Device Type Abbreviations:

DateID Location Description

Device

Type

Pass/Fail or

Not Tested Comments

DACT

DART

RAT

McCulloh

DACT = Digital Alarm Communicator Transmitter RAT = Radio Alarm Transmitter

DART = Digital Alarm Radio Transmitter McC = McCulloh

Device

Type

Device Type Abbreviations:

DateID

Periodicity:

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

SIGNAL TRANSMISSION EQUIPMENT LIST

ST Job ID: Date:

Property's Contact: Property Name:

Location Description

Pass/Fail or

Not Tested Comments

AHU Shutdowns

RLY = Relay DSDR = Duct detector with built in relay

Device Type Abbreviations:

Periodicity:

CURRENT INSPECTION COUNTS

Quantity

Installed

Quantity

Tested

Quantity

Not Tested

Quantity

Passed

Quantity

Failed

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

AHU SHUTDOWN LIST

ST Job ID: Date:

Property's Contact: Property Name:

Date

Device Type

Used for

Shutdown

ID of device

Used for

Shutdown CommentsAHU ID

Shutdown

Pass/Fail or

Not TestedAHU Location Description

Rolling Door Sliding Door

RD = Rolling Door SD = Sliding Door

DateID Location Description

Device

Type

Pass/Fail or

Not Tested Comments

Device Type Abbreviations:

ROLLING & SLIDING DOOR LIST

ST Job ID: Date:

Property's Contact: Property Name:

CURRENT INSPECTION COUNTS

Quantity Installed

Quantity Tested

Quantity Not Tested

Quantity Passed

Quantity Failed

Service Tech: State:

Tech Cert/License: Zip:

System ID: Property Address:

System Location: City:

Periodicity:

Manufacturer: Name:

Phone Number:

Account Number:

Model:

Special Hazards and/or Procedures to be Aware of Prior to Disable:

Panel/Node:

Tech Cert/License: Zip:

Take Down Procedures:

Periodicity:

Control Unit Monitoring Entity

Service Tech: State:

Property's Contact: Property Name:

System ID: Property Address:

System Location: City:

TAKE DOWN SHEET

The following was noted:

Periodicity:

Property Address:

System Location: City:

System ID:

Service Tech: State:

Tech Cert/License: Zip:

Property's Contact: Property Name:

SUPPLEMENTAL COMMENTS

The strobes and horn strobes in F, NMR, and H wings did not work