Fire_Alarm_Testing_-_01-18.pdf

Fire Alarm and Life Safety System Inspection Certificate

For

Fort Hall Indian Health Center 717 Mission Road Fort Hall, ID 83203

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 Date Jan 14, 2018

Building: Fort Hall Indian Health Center Company: Mountain Alarm - Ogden Contact: Jeremy Friday Contact: Adam Scott

Title: Facilities Manager Title: Inspector

Page of 1 12 Executive Summary

Mountain Alarm - Ogden 01/15/2018

Executive Summary Generated by: BuildingReports.com

Building Information Building: Fort Hall Indian Health Center Contact: Jeremy Friday Address: 717 Mission Road Phone: 208-238-5414 Address: Fax: 208-238-5463 City/State/Zip: Fort Hall, ID 83203 Mobile:

Country: United States of America Email: jeremy.friday@ihs.gov

Inspection Performed By Company: Mountain Alarm - Ogden Inspector: Adam Scott Address: 3293 Harrison Blvd. Phone: 385-405-6478 Address: Fax:

City/State/Zip: Ogden, UT 84403 Mobile: 385-405-6478 Country: United States of America Email: ascott@fpsservice.com

System Control Unit Manufacturer: Notifier Inspection Date: IDC Style: A Model Number: 5000 Install Date: 07/21/2011 SLC Style: 6 Software Version: Version Date: 07/21/2011 NAC Style: Y Location: 1st Main Electrical Room Current Protection: Breaker

Monitoring Company: Phone: Account #:

Central Station Signal Verification Type: Digital Communicator Mfg: Radionics Model #: D2071 Test Time/Date: Restore Time:

Page of 2 12 Executive Summary

Mountain Alarm - Ogden 01/15/2018

Inspection Summary

Category:

Total Items Serviced Passed Failed/Other

Qty % Qty % Qty % Qty % Supervisory 2 2.56% 2 100.00% 2 100.00% 0 0%

Auxiliary 1 1.28% 0 0% 0 0% 0 0%

Sound Test 2 2.56% 0 0% 0 0% 0 0%

Initiating 68 87.18% 22 32.35% 22 100.00% 0 0%

Control 5 6.41% 0 0% 0 0% 0 0%

Totals 78 100% 24 30.77% 24 100.00% 0 0%

Certification Company: Mountain Alarm - Ogden Building: Fort Hall Indian Health Center Inspector: Adam Scott Contact: Jeremy Friday

Page of 3 12 Inspection & Testing

Mountain Alarm - Ogden 01/15/2018

Inspection & Testing Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center Control Panel: 1 - Notifier 5000 The Inspection & Testing section lists all of the items inspected in your building. Items are grouped by Passed or

. Items are listed by Category. Each item includes the services performed, and the time & date at which testing Failed/Other occurred.

Device Type Location Service Time Date

Passed Initiating

Heat Detector 1st Maintenance Room Tested 10:27:57 PM 01/14/2018 Heat Detector 1st Maintenance Room Tested 10:27:59 PM 01/14/2018 Heat Detector 1st Mechanical Room Tested 10:27:54 PM 01/14/2018

Pull Station 1st Maintenance Shop Tested 10:27:29 PM 01/14/2018 Pull Station 1st Mechanical Room Tested 10:27:25 PM 01/14/2018 Pull Station 1st Northwest Entrance Tested 10:27:46 PM 01/14/2018

Smoke Detector 1st Ceiling Front Entrance Tested 10:27:22 PM 01/14/2018 Smoke Detector 1st Central Supply Tested 10:27:31 PM 01/14/2018 Smoke Detector 1st Dental Hall Outside Room 106 Tested 10:27:44 PM 01/14/2018 Smoke Detector 1st Hall Outside 142 Tested 10:27:19 PM 01/14/2018 Smoke Detector 1st Hall Outside Exam Room 212 Tested 10:27:36 PM 01/14/2018 Smoke Detector 1st Hall Outside Room 159 Tested 10:26:04 PM 01/14/2018 Smoke Detector 1st Hall Outside Room 205 Tested 10:27:39 PM 01/14/2018 Smoke Detector 1st Hall Outside Room 260 Tested 10:27:50 PM 01/14/2018 Smoke Detector 1st Janitor Closet 121 Tested 10:27:41 PM 01/14/2018 Smoke Detector 1st Lab Room 241 Tested 10:27:33 PM 01/14/2018 Smoke Detector 1st Loading Dock Doors Tested 10:26:09 PM 01/14/2018 Smoke Detector 1st Outpatient Care Outside Room 217 Tested 10:27:16 PM 01/14/2018 Smoke Detector 1st Storage Room 141 Tested 10:26:07 PM 01/14/2018 Smoke Detector 1st Tribal Waiting Outside Hall 252 Tested 10:26:01 PM 01/14/2018 Smoke Detector 1st West Door Hall Outside Room 142 Tested 10:27:52 PM 01/14/2018 Waterflow Switch 1st Mechanical Room Tested 10:26:37 PM 01/14/2018

Supervisory Tamper Switch 1st Mechanical Room Tested 10:26:40 PM 01/14/2018 Tamper Switch 1st Mechanical Room Tested 10:26:43 PM 01/14/2018

Untested Auxiliary

Releasing Device 1st Main Electrical Room FACP

Control Annunciator 1st Administration

Battery 1st Main Electrical Room Battery 1st Main Electrical Room

Communicator 1st Main Electrical Room

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Mountain Alarm - Ogden 01/15/2018

Device Type Location Service Time Date Control Panel 1st Main Electrical Room

Initiating Duct Detector 1st Mechanical Room AHU-1 Duct Detector 1st Mechanical Room RAF-1 Heat Detector 1st Maintenance Shop Supply Room Heat Detector 1st Mechanical Room Heat Detector 1st Mechanical Room Air Handler Area

Pull Station 1st Hall Outside Maintenance Shop Pull Station 1st Hall Outside Room 217 Pull Station 1st Main Entry

Smoke Detector 1st Administration Smoke Detector 1st Copy Room Room 145 Smoke Detector 1st Dental Lab Area Smoke Detector 1st Dental Waiting Smoke Detector 1st Employee Break Room Smoke Detector 1st Files By Radiology Smoke Detector 1st Hall Exit Outside Room 136 Smoke Detector 1st Hall Outside Restoom 120 Smoke Detector 1st Hall Outside Room 147 Smoke Detector 1st Hall Outside Room 186 Smoke Detector 1st Hall Outside Room 193 Smoke Detector 1st Hall Outside Room 202 Smoke Detector 1st Hall Outside Room 207 Smoke Detector 1st Hall Outside Room 221 Smoke Detector 1st Hall Outside Room 222 Smoke Detector 1st Hall Outside Room 250 Smoke Detector 1st Hall Outside Room 251 Smoke Detector 1st Hall Outside Room 267 Smoke Detector 1st Janitor Room 190 Smoke Detector 1st Lab Area Smoke Detector 1st Mail Room Smoke Detector 1st Main Electrical Room Smoke Detector 1st Maintenance Shop Office Smoke Detector 1st Outpaient Waiting Area 199 Smoke Detector 1st Outpaient Waiting by Room 199 Smoke Detector 1st Outpatient Waiting Area 191 Smoke Detector 1st Outside Room 185 Smoke Detector 1st Outside Room 229 Smoke Detector 1st Outside Tribe Services Exit Smoke Detector 1st Pharmacy Smoke Detector 1st Reception Area 199 Smoke Detector 1st Room 266 Smoke Detector 1st Room 266 Supply Smoke Detector 1st Staff Mens Locker Room Smoke Detector 1st Staff Womens Locker Room

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Mountain Alarm - Ogden 01/15/2018

Device Type Location Service Time Date Smoke Detector 1st Tribal Service Waiting Smoke Detector 1st Tribes room 139 Janitor Closet Smoke Detector 1st Waiting Outside Pharmacy

Page of 6 12 Service Summary

Mountain Alarm - Ogden 01/15/2018

Service Summary Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center The Service Summary section provides an overview of the services performed in this report.

Device Type Service Quantity

Passed Heat Detector Tested 3 Pull Station Tested 3 Smoke Detector Tested 15 Tamper Switch Tested 2 Waterflow Switch Tested 1 Total 24

Untested Annunciator 1 Battery 2 Communicator 1 Control Panel 1 Duct Detector 2 Heat Detector 3 Pull Station 3 Releasing Device 1 Smoke Detector 38 Total 52

Page of 7 12 Auxiliary Functions Testing

Mountain Alarm - Ogden 01/15/2018

Auxiliary Functions Testing Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center Control Panel: 1 - Notifier 5000 The Auxiliary Functions Testing section lists each of the ancillary items, systems, and emergency equipment that are controlled by the system control unit. Items are grouped by Passed or Failed/Other. The items are listed by device type, and a check box is provided to indicate if the test conducted was simulated.

Type Location Comment ScanID Simulated

Untested Releasing Device Door Holder 1st Main Electrical Room FACP 16745148

Page of 8 12 Sound and Visual Testing

Mountain Alarm - Ogden 01/15/2018

Sound and Visual Testing Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center The Sound and Visual Testing section lists various points throughout your building where audible and visual alarm notification devices were tested. Any bar-coded audible and visual devices will appear in the Inspection and Testing section of this report. Items in this section are grouped by Passed or Failed/Other. Where specific decibel readings were recorded, they will appear under the ambient and alarm columns. The Voice column indicates whether the Sound Test Point passed the Voice Intelligibility requirements. The STI or Sound Transmission Index is shown if recorded.

Location Comment Ambient Alarm Intelligibility Sound

TestVoice STI

Untested Sound Test Points 1st Entire Health Center 0001 1st Entire Health Center 0002

Page of 9 12 Smoke Management Testing

Mountain Alarm - Ogden 01/15/2018

Smoke Management Testing Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center Control Panel: 1 - Notifier 5000 The Smoke Management Testing section details the test and inspection of device items that are involved in controlling the spread of smoke in a building. Items are grouped by Passed or Failed/Other.

Location Description Comment ScanID Simulated

Untested Releasing Device 1st Main Electrical Room FACP Door Holder 16745148

Page of 10 12 Inventory & Warranty Report

Mountain Alarm - Ogden 01/15/2018

Inventory & Warranty Report Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center Control Panel: 1 - Notifier 5000 The Inventory & Warranty Report lists each of the devices and items that are included in your Inspection Report. A complete inventory count by device type and category is provided. Items installed within the last 90 days, within the last year, and devices installed for two years or more are grouped together for easy reference.

Device or Item Category % of Inventory Quantity Smoke Detector Initiating 67.95% 53

Pull Station Initiating 7.69% 6

Heat Detector Initiating 7.69% 6

Duct Detector Initiating 2.56% 2

Releasing Device Auxiliary 1.28% 1

Annunciator Control 1.28% 1

Control Panel Control 1.28% 1

Battery Control 2.56% 2

Communicator Control 1.28% 1

Waterflow Switch Initiating 1.28% 1

Tamper Switch Supervisory 2.56% 2

Type Qty Model # Description Install Date

In Service - 5 Years to 10 Years Releasing Device 1 Door Holder 07/21/2011

Fenwal Smoke Detector 34 7021 Photoelectric 07/21/2011

Notifier Annunciator 1 LED List 07/21/2011 Control Panel 1 5000 07/21/2011 Pull Station 6 BNG-1 Single Action 07/21/2011 Smoke Detector 1 BNG-1 07/21/2011

Potter Electric Tamper Switch 2 OSYSU-2 07/21/2011 Waterflow Switch 1 VSR-F 07/21/2011

Radionics Communicator 1 D2071 Digital Communicator 07/21/2011

System Sensor Duct Detector 2 DH1851 Photoelectric 07/21/2011 Smoke Detector 1 1400 Ionization 07/21/2011 Smoke Detector 17 1400 Photoelectric 07/21/2011

Thermatec Heat Detector 6 135 Degree Fixed Temperature 07/21/2011

Universal Battery Battery 1 UB1218 Sealed Lead Acid 07/21/2011 Battery 1 UB1218 Sealed Lead Acid 05/06/2010

Page of 11 12 Zone Address Report

Mountain Alarm - Ogden 01/15/2018

Zone Address Report Generated by: BuildingReports.com

Building: Fort Hall Indian Health Center Control Panel: 1 - Notifier 5000 The Zone Address Report lists all of the devices and items that have an individual address, or are grouped together under a common zone. The device type, location, and description are included for your reference.

Address Device Type Location Type ScanID Blue Smoke Detector 1st Administration Photoelectric 17117856 Blue Smoke Detector 1st Employee Break Room Photoelectric 17117854 Blue Smoke Detector 1st Files By Radiology Photoelectric 17117864 Blue Smoke Detector 1st Hall Outside Room 159 Photoelectric 16745139 Blue Smoke Detector 1st Hall Outside Room 207 Photoelectric 17117863 Blue Smoke Detector 1st Hall Outside Room 250 Photoelectric 17117853 Blue Smoke Detector 1st Janitor Room 190 Photoelectric 17117861 Blue Smoke Detector 1st Loading Dock Doors Photoelectric 17117852 Blue Smoke Detector 1st Mail Room Photoelectric 17117858 Blue Smoke Detector 1st Outpaient Waiting Area 199 Photoelectric 19927535 Blue Smoke Detector 1st Pharmacy Photoelectric 19927536 Blue Smoke Detector 1st Storage Room 141 Photoelectric 16745142 Blue Smoke Detector 1st Tribal Waiting Outside Hall 252 Photoelectric 16745137 Blue Smoke Detector 1st Waiting Outside Pharmacy Photoelectric 17117860

Green Smoke Detector 1st Ceiling Front Entrance Photoelectric 17117859 Green Smoke Detector 1st Central Supply Photoelectric 18613419 Green Smoke Detector 1st Dental Hall Outside Room 106 Photoelectric 18613423 Green Smoke Detector 1st Hall Outside 142 Photoelectric 17117855 Green Smoke Detector 1st Hall Outside Exam Room 212 Photoelectric 18613421 Green Smoke Detector 1st Hall Outside Room 205 Photoelectric 18613422 Green Smoke Detector 1st Hall Outside Room 260 Photoelectric 18613426 Green Smoke Detector 1st Janitor Closet 121 Photoelectric 18613424 Green Smoke Detector 1st Lab Room 241 Photoelectric 18613420 Green Heat Detector 1st Maintenance Room Fixed Temperature 18613429 Green Heat Detector 1st Maintenance Room Fixed Temperature 18613430 Green Pull Station 1st Maintenance Shop Single Action 18613418 Green Heat Detector 1st Mechanical Room Fixed Temperature 18613428 Green Pull Station 1st Mechanical Room Single Action 18613417 Green Duct Detector 1st Mechanical Room AHU-1 Photoelectric 16745146 Green Pull Station 1st Northwest Entrance Single Action 18613425 Green Smoke Detector 1st Outpatient Care Outside Room 217 Photoelectric 16745121 Green Smoke Detector 1st West Door Hall Outside Room 142 18613427 Orange Smoke Detector 1st Copy Room Room 145 Photoelectric 16745140 Orange Smoke Detector 1st Dental Lab Area Photoelectric 16745135 Orange Smoke Detector 1st Hall Exit Outside Room 136 Photoelectric 16745141 Orange Pull Station 1st Hall Outside Maintenance Shop Single Action 16745112 Orange Smoke Detector 1st Hall Outside Restoom 120 Photoelectric 16745134

Page of 12 12 Zone Address Report

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Address Device Type Location Type ScanID Orange Smoke Detector 1st Hall Outside Room 193 Photoelectric 16745129 Orange Pull Station 1st Hall Outside Room 217 Single Action 16745126 Orange Smoke Detector 1st Hall Outside Room 221 Photoelectric 16745124 Orange Smoke Detector 1st Hall Outside Room 251 Photoelectric 16745118 Orange Smoke Detector 1st Main Electrical Room Photoelectric 16745143 Orange Heat Detector 1st Maintenance Shop Supply Room Fixed Temperature 16745114 Orange Heat Detector 1st Mechanical Room Fixed Temperature 16745144 Orange Heat Detector 1st Mechanical Room Air Handler Area Fixed Temperature 16745145 Orange Duct Detector 1st Mechanical Room RAF-1 Photoelectric 16745147 Orange Smoke Detector 1st Outpatient Waiting Area 191 Photoelectric 16745120 Orange Smoke Detector 1st Outside Room 185 Photoelectric 16745131 Orange Smoke Detector 1st Outside Tribe Services Exit Photoelectric 16745136 Orange Smoke Detector 1st Room 266 Photoelectric 16745116 Orange Smoke Detector 1st Staff Mens Locker Room Photoelectric 23488525 Orange Smoke Detector 1st Staff Womens Locker Room Photoelectric 23488526

Pink Smoke Detector 1st Dental Waiting Photoelectric 16745132 Pink Smoke Detector 1st Hall Outside Room 147 Photoelectric 19927537 Pink Smoke Detector 1st Hall Outside Room 186 Photoelectric 16745128 Pink Smoke Detector 1st Hall Outside Room 202 Photoelectric 16745127 Pink Smoke Detector 1st Hall Outside Room 222 Photoelectric 16745125 Pink Smoke Detector 1st Hall Outside Room 267 Photoelectric 16745115 Pink Smoke Detector 1st Lab Area Photoelectric 16745123 Pink Pull Station 1st Main Entry Single Action 16745133 Pink Smoke Detector 1st Maintenance Shop Office Ionization 16745113 Pink Smoke Detector 1st Outpaient Waiting by Room 199 Photoelectric 16745130 Pink Smoke Detector 1st Outside Room 229 Photoelectric 16745122 Pink Smoke Detector 1st Reception Area 199 Photoelectric 16745119 Pink Smoke Detector 1st Room 266 Supply Photoelectric 16745117 Pink Smoke Detector 1st Tribal Service Waiting Photoelectric 34636168 Pink Smoke Detector 1st Tribes room 139 Janitor Closet Photoelectric 24346031