Tampa-VAMC-Bldgs-_41-42-53-54-55-63-64_-_June_2018.pdf

Fire Alarm and Life Safety System

Inspection Certificate

For

Tampa VAMC Bldg 41

13000 Bruce B Downs Blvd

Tampa,FL 33637

Kinetix has performed this inspection and testing service in compliance with The Joint

Commission/VHA Standards. The inspection/testing frequencies adhered to for this service have been performed in accordance with The Joint Commission/VHA Memorandum 23 Concurrence on EC &

LS Standards effective September 2017. 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 Completion Date

Jun 14, 2018

Building: Tampa VAMC Bldg 41 Company: Kinetix

Contact: Darren Matteson Contact: Michael Gill

Title: Biomedical Engineer Title: Field Supervisor/Technician

Kinetix 1 07/13/2018

Executive Summary Generated by: BuildingReports.com

Building Information

Building: Tampa VAMC Bldg 41 Contact: Darren Matteson

Address: 13000 Bruce B Downs Blvd Phone: 813-972-2000

Address: Fax:

City/State/Zip: Tampa, FL 33637 Mobile:

Country: United States of America Email:

Inspection Performed By

Company: Kinetix Inspector: Michael Gill

Address: 12 Creek Parkway Phone: 386-747-2294

Address: Fax: 3145020737

City/State/Zip: Boothwyn, PA 19061 Mobile:

Country: United States of America Email: michaelgill15@yahoo.com

Monitoring Company: Phone: Account #:

Central Station Signal Verification Type: Digital Communicator Mfg: Simplex Model #:

Test Time/Date: 6/14/18 8:27:53 AM Restore Time

Kinetix 2 07/13/2018

Inspection Completion Date: Jun 14, 2018

Building: Tampa VAMC Bldg 41

EC 02.03.05 EP 02

Semi-annual testing of water flow devices and valve tamper switches

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Tamper Switch 0 0 0 8 0 8

EC 02.03.05 EP 03

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Heat Detector 2 2 0 2 0 2

Pull Station 5 5 0 5 0 5

Smoke Detector 40 40 0 40 0 40

EC 02.03.05 EP 04

Annual test of visual and audible fire alarms, including speakers and door releasing devices

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Speaker/Strobe 32 32 0 32 0 32

Strobe 5 5 0 5 0 5

EC 02.03.05 EP 05

Annual test of fire alarm equipment for notifying off-site fire responders

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018)

Communicator 1 1 0 1 0 1

LS 02.01.34 EP 04

All other Life Safety Code fire alarm requirements related to NFPA 101-2018

18/19.3.4

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018)

Battery 0 0 0 0 2 2

LS 02.01.50 EP 04

Elevators are fully equipped and protected

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Elevator 1 1 0 1 0 1

Total Device Count: 96

Kinetix 3 07/13/2018

Certification

Company: Kinetix Building: Tampa VAMC Bldg 41

Inspector: Michael Gill Contact: Darren Matteson

Signed: Signed:

Kinetix 4 07/13/2018

Notes & Recommendations

Building: Tampa VAMC Bldg 41 Control Panel: n/a

The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection.

ScanID Note Device Type Location Comment

EC 02.03.05 EP 03 Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

40665800 1 Smoke Detector 1 ELEV. LOBBY Passed

Recalls To Alternate Floor

40665801 2 Smoke Detector 1 ELEV. MECH. RM 41-126 Passed

Recalls To Primary Floor

40665841 3 Smoke Detector 2 ELEV. LOBBY Passed

Recalls To Primary Floor

40665842 4 Smoke Detector 2 ELEV. TOP SHAFT Passed

Recalls To Primary Floor

Kinetix 5 07/13/2018

Inspection & Testing

The Inspection & Testing section lists all of the items inspected in your building, which are then categorized by the applicable code reference. The most recent inspection is listed in the far right column and is based on the Finish Date of that inspection. The latest inspection uploaded in each previous quarter appears in the four columns to the left.

Passed=P, Failed=F, Replaced=R

EC 02.03.05 EP 02

Semi-annual testing of water flow devices and valve tamper switches

Operate valve and verify signal receipt shall be verified to be within the first two revolutions of the hand wheel or within one-fifth of the travel distance, or per the manufacturer's published instructions. (NFPA 72 Table 14.4.3.2 (17)(j)(1))

Devices Tested Q2/18 Pass Q2/18 Fail Q2/18 Tested YTD (2018) Total Quantity

Tamper Switch 0 0 0 8 8

Device Type Location ScanID Address Q2/17 Q1/18 Q2/18

Tamper Switch 1 East Exit 40665836 0-12:M1-03 01/12-P

Tamper Switch 1 RISER RM 41-101 OUTSIDE 40665837 0-12:M1-04 01/12-P

Tamper Switch 1 FL by stairwell 2 41858078 1-6:M1-31-0 01/12-P

Tamper Switch 1 FL East Exit 41858079 1-12:M1-3-0 01/12-P

Tamper Switch 2FL Stairwell 2 41858076 1-17:M1-170-

01/12-P

Tamper Switch BLDG Basement 41858075 1-6:M1-14-0 01/12-P

Tamper Switch BLDG Basement 41858074 1-6:M1-31-0 01/12-P

Tamper Switch BLG32 Tunnel 41858077 1-6:M1-31-0 01/12-P

Device Total: 8

Kinetix 6 07/13/2018

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Restorable: Perform heat test with a listed and labeled heat source or in accordance with the manufacturer's published instructions. Non-

Restorable: Do not perform heat test. Test functionality mechanically and electrically. (NFPA 72 Table 14.4.3.2 (17)(d))

Heat Detector 2 2 0 2 2

Heat Detector 1 ELEV MECH RM 41-126 40665795 0-12:M1-09 06/22-P 06/12-P

Heat Detector 2 ELEV. TOP SHAFT 40665838 0-12:M1-14 06/22-P 06/12-P

Device Total: 2

Kinetix 7 07/13/2018

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Operate manual fire alarm boxes per the manufacturer's published instructions. Test both key-operated presignal and general alarm manual fire alarm boxes. (NFPA 72 Table 14.4.3.2 (17e))

Pull Station 5 5 0 5 5

Pull Station 1 NORTH EXIT 40665797 0-12:M1-05 06/27-P 06/14-P

Pull Station 1 WEST EXIT 40665798 0-12:M1-07 06/30-P 06/14-P

Pull Station 1 EAST EXIT 40665796 0-12:M1-02 06/27-P 06/14-P

Pull Station 2 BY EAST STAIRWELL 40665839 0-12:M1-11 06/27-P 06/14-P

Pull Station 2 BY WEST STAIRWELL 40665840 0-12:M1-15 06/30-P 06/14-P

Device Total: 5

Kinetix 8 07/13/2018

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Test smoke detectors in place to ensure smoke entry into the sensing chamber and an alarm response. (NFPA 72 Table 14.4.3.2 (17)(g)(1))

Smoke Detector 40 40 0 40 40

Smoke Detector 1 ELEV. MECH. RM 41-126 40665801 0-12:M1-08 06/22-P 06/12-P

Smoke Detector 1 ELEV. LOBBY 40665800 0-12:M1-06 06/22-P 06/12-P

Smoke Detector 1 BY ROOM 127 40665804 0-12:M1-26 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 117 40665805 0-12:M1-29 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 105 40665808 0-12:M1-32 06/30-P 06/14-P

Smoke Detector 1 BY ROOM 103 40665810 0-12:M1-35 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 140 40665813 0-12:M1-39 06/30-P 06/14-P

Smoke Detector 1 LOUNGE 40665812 0-12:M1-37 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 146 40665814 0-12:M1-40 06/30-P 06/14-P

Smoke Detector 1 BY ROOM 137 40665811 0-12:M1-36 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 150 40665815 0-12:M1-42 06/30-P 06/14-P

Smoke Detector 1 BY ROOM 152 40665816 0-12:M1-43 06/30-P 06/14-P

Smoke Detector 1 BY ROOM 158 40665817 0-12:M1-44 06/30-P 06/14-P

Smoke Detector 1 BY REST ROOM 40665818 0-12:M1-75 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 120 40665819 0-12:M1-76 06/30-P 06/14-P

Smoke Detector 1 LOBBY RECEPTION 40665809 0-12:M1-33 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 115 40665806 0-12:M1-30 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 134 40665803 0-12:M1-25 06/27-P 06/14-P

Smoke Detector 1 BY ROOM 107 40665807 0-12:M1-31 06/27-P 06/14-P

Smoke Detector 1 FILE RM 41-118 40665802 0-12:M1-17 06/30-P 06/14-P

Smoke Detector 1 ABOVE FACP 40665799 0-12:M1-01 06/28-P 06/14-P

Smoke Detector 2 ELEV. TOP SHAFT 40665842 0-12:M1-13 06/22-P 06/12-P

Smoke Detector 2 ELEV. LOBBY 40665841 0-12:M1-12 06/22-P 06/12-P

Smoke Detector 2 BY ROOM 226 40665843 0-12:M1-48 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 220 40665845 0-12:M1-50 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 217 40665846 0-12:M1-53 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 214 40665847 0-12:M1-54 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 223 40665844 0-12:M1-49 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 209 40665848 0-12:M1-56 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 205 40665849 0-12:M1-57 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 203 40665850 0-12:M1-59 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 228 40665851 0-12:M1-61 06/27-P 06/14-P

Smoke Detector 2 LOUNGE 40665852 0-12:M1-62 06/27-P 06/14-P

Smoke Detector 2 BY REST ROOM 40665853 0-12:M1-63 06/27-P 06/14-P

Smoke Detector 2 BY ROOM 234 40665854 0-12:M1-67 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 237 40665855 0-12:M1-68 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 239 40665856 0-12:M1-69 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 243 40665857 0-12:M1-71 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 245 40665858 0-12:M1-72 06/30-P 06/14-P

Smoke Detector 2 BY ROOM 230 40665859 0-12:M1-73 06/30-P 06/14-P

Device Total: 40

Kinetix 9 07/13/2018

Annual test of visual and audible fire alarms, including speakers and door releasing devices

For periodic testing, verify the operation of the notification appliances. (NFPA 72 Table 14.4.3.2 (22)(b))

Speaker/Strobe 32 32 0 32 32

Speaker/Strobe 1 BY RM 41-129 40665826 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-120 40665825 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-135 40665827 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-151 40665829 0 06/30-P 06/14-P

Speaker/Strobe 1 INSIDE RM 41-118 40665832 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-158 40665831 0 06/30-P 06/14-P

Speaker/Strobe 1 INSIDE RM 41-158 40665833 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-154 40665830 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-140 40665828 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-118 40665824 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-111 40665823 0 06/30-P 06/14-P

Speaker/Strobe 1 BY RM 41-105 40665822 0 06/30-P 06/14-P

Speaker/Strobe 1 BY ELEV. LOBBY 40665821 0 06/30-P 06/14-P

Speaker/Strobe 1 BREAK RM 40665820 0 06/30-P 06/14-P

Speaker/Strobe 2 BREAK AREA 40665860 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-204 40665861 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-207 40665862 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-214 40665863 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-219 40665864 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-223 40665865 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-226 40665866 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-229 40665867 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-231 40665868 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-233 40665869 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-237 40665870 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-239 40665871 0 06/30-P 06/14-P

Speaker/Strobe 2 BY RM 41-245 40665872 0 06/30-P 06/14-P

Speaker/Strobe 2 CORNER BY RM 41-231 40665874 0 06/30-P 06/14-P

Speaker/Strobe 2 INSIDE RM 41-233 40665875 0 06/30-P 06/14-P

Speaker/Strobe 2 BY STAIRWELL EAST BY 41-219 40665873 0 06/30-P 06/14-P

Speaker/Strobe 2 INSIDE RM 41-237 40665876 0 06/30-P 06/14-P

Speaker/Strobe 2 MEETING RM 41-222 40665877 0 06/30-P 06/14-P

Device Total: 32

Kinetix 10 07/13/2018

Annual test of visual and audible fire alarms, including speakers and door releasing devices

For periodic testing, verify that each appliance flashes. (NFPA 72 Table 14.4.3.2 (22c))

Strobe 5 5 0 5 5

Strobe 1 WOMENS BATHROOM 40665835 0 06/30-P 06/14-P

Strobe 1 MENS BATHROOM 40665834 0 06/30-P 06/14-P

Strobe 2 RM 41-231 40665879 0 06/30-P 06/14-P

Strobe 2 MENS BATHROOM 40665878 0 06/30-P 06/14-P

Strobe 2 WOMENS BATHROOM 40665880 0 06/30-P 06/14-P

Device Total: 5

Kinetix 11 07/13/2018

Annual test of fire alarm equipment for notifying off-site fire responders

Test all system functions and features in accordance with the equipment manufacturer's published instructions for correct operation in conformance with the applicable sections of Chapter 26. Except for DACT, actuate initiating device and verify receipt of the correct initiating device signal at the supervising station within 90 seconds. Upon completion of the test, restore the system to its functional operating condition. (NFPA 72 Table 14.4.3.2 (4))

Communicator 1 1 0 1 1

Communicator 1st In Bldg 39 40662943 1 06/28-P 06/14-P

Device Total: 1

Kinetix 12 07/13/2018

All other Life Safety Code fire alarm requirements related to NFPA 101-2018 18/19.3.4

With the batteries fully charged and connected to the charger, measure the voltage across the batteries with a voltmeter. Then, with the battery charger disconnected, load test the batteries following the manufacturer's recommendations. (NFPA 72 Table 14.4.3.2 (9))

Battery 0 0 0 0 2

Battery 42020001 1-12V-33Ah 06/28-P

Battery 42020000 1-12V-33Ah 06/28-P

Kinetix 13 07/13/2018

Elevators are fully equipped and protected

Test interface equipment connections by operating or simulating the equipment being supervised. Verify signals required to be transmitted are received at the control unit. (NFPA 72 Table 14.4.3.2 (20))

Elevator 1 1 0 1 1

Elevator Ground Elevator 23 Recall 40665794 0-MISC 06/22-P 06/14-P

Kinetix 14 07/13/2018

Service Summary

The Service Summary section provides an overview of the services performed in this report.

Device Type Service Quantity

Passed Communicator Tested 1

Elevator Tested 1

Heat Detector Tested 2

Pull Station Tested 5

Smoke Detector Tested/Cleaned 40

Speaker/Strobe Tested 32

Strobe Tested 5

Total 86

Untested Battery 2

Tamper Switch 8

Total 10

Kinetix 15 07/13/2018

Auxiliary Functions Testing

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

Passed

Heat Detector

Shunt Trip 1 ELEV MECH RM 41-126 Passed 40665795

Shunt Trip 2 ELEV. TOP SHAFT Passed 40665838

Smoke Detector

Elevator Recall 1 ELEV. LOBBY Passed 40665800

Elevator Recall 1 ELEV. MECH. RM 41-126 Passed 40665801

Elevator Recall 2 ELEV. LOBBY Passed 40665841

Elevator Recall 2 ELEV. TOP SHAFT Passed 40665842

Elevator

Primary Recall Ground Elevator 23 Recall Passed 40665794

Kinetix 16 07/13/2018

Inventory & Warranty Report

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

Tamper Switch Supervisory 8.33% 8

Battery Control 2.08% 2

Smoke Detector Initiating 41.67% 40

Heat Detector Initiating 2.08% 2

Elevator Auxiliary 1.04% 1

Communicator Control 1.04% 1

Pull Station Initiating 5.21% 5

Speaker/Strobe Indicating 33.33% 32

Strobe Indicating 5.21% 5

Type Qty Model # Description Install Date

In Service - 1 Year to 2 Years

Simplex

Tamper Switch 2 08/19/2016

In Service - 2 Years to 3 Years

Simplex

Pull Station 5 06/16/2016

Smoke Detector 36 Photoelectric 06/16/2016

Speaker/Strobe 31 06/16/2016

Strobe 5 06/16/2016

Elevator 1 Primary Recall 06/08/2016

Heat Detector 2 06/08/2016

Smoke Detector 3 Photoelectric 06/08/2016

Speaker/Strobe 1 06/08/2016

Smoke Detector 1 Photoelectric 06/07/2016

Kinetix 17 07/13/2018

Building: Tampa VAMC Bldg 41 Control Panel: 1

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.

Type Qty Model # Description Install Date

In Service - 1 Year to 2 Years Battery 2 Sealed Lead Acid 06/28/2017

Tamper Switch 6 02/19/2017

Simplex

Communicator 1 Digital Communicator 08/19/2016

Kinetix 18 07/13/2018

Zone Address Report

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

12:M1-01 Smoke Detector 1 ABOVE FACP Photoelectric 40665799

12:M1-02 Pull Station 1 EAST EXIT 40665796

12:M1-05 Pull Station 1 NORTH EXIT 40665797

12:M1-06 Smoke Detector 1 ELEV. LOBBY Photoelectric 40665800

12:M1-07 Pull Station 1 WEST EXIT 40665798

12:M1-08 Smoke Detector 1 ELEV. MECH. RM 41-126 Photoelectric 40665801

12:M1-09 Heat Detector 1 ELEV MECH RM 41-126 40665795

12:M1-11 Pull Station 2 BY EAST STAIRWELL 40665839

12:M1-12 Smoke Detector 2 ELEV. LOBBY Photoelectric 40665841

12:M1-13 Smoke Detector 2 ELEV. TOP SHAFT Photoelectric 40665842

12:M1-14 Heat Detector 2 ELEV. TOP SHAFT 40665838

12:M1-15 Pull Station 2 BY WEST STAIRWELL 40665840

12:M1-17 Smoke Detector 1 FILE RM 41-118 Photoelectric 40665802

12:M1-25 Smoke Detector 1 BY ROOM 134 Photoelectric 40665803

12:M1-26 Smoke Detector 1 BY ROOM 127 Photoelectric 40665804

12:M1-29 Smoke Detector 1 BY ROOM 117 Photoelectric 40665805

12:M1-30 Smoke Detector 1 BY ROOM 115 Photoelectric 40665806

12:M1-31 Smoke Detector 1 BY ROOM 107 Photoelectric 40665807

12:M1-32 Smoke Detector 1 BY ROOM 105 Photoelectric 40665808

12:M1-33 Smoke Detector 1 LOBBY RECEPTION Photoelectric 40665809

12:M1-35 Smoke Detector 1 BY ROOM 103 Photoelectric 40665810

12:M1-36 Smoke Detector 1 BY ROOM 137 Photoelectric 40665811

12:M1-37 Smoke Detector 1 LOUNGE Photoelectric 40665812

12:M1-39 Smoke Detector 1 BY ROOM 140 Photoelectric 40665813

12:M1-40 Smoke Detector 1 BY ROOM 146 Photoelectric 40665814

12:M1-42 Smoke Detector 1 BY ROOM 150 Photoelectric 40665815

12:M1-43 Smoke Detector 1 BY ROOM 152 Photoelectric 40665816

12:M1-44 Smoke Detector 1 BY ROOM 158 Photoelectric 40665817

12:M1-48 Smoke Detector 2 BY ROOM 226 Photoelectric 40665843

12:M1-49 Smoke Detector 2 BY ROOM 223 Photoelectric 40665844

12:M1-50 Smoke Detector 2 BY ROOM 220 Photoelectric 40665845

12:M1-53 Smoke Detector 2 BY ROOM 217 Photoelectric 40665846

12:M1-54 Smoke Detector 2 BY ROOM 214 Photoelectric 40665847

12:M1-56 Smoke Detector 2 BY ROOM 209 Photoelectric 40665848

12:M1-57 Smoke Detector 2 BY ROOM 205 Photoelectric 40665849

12:M1-59 Smoke Detector 2 BY ROOM 203 Photoelectric 40665850

12:M1-61 Smoke Detector 2 BY ROOM 228 Photoelectric 40665851

12:M1-62 Smoke Detector 2 LOUNGE Photoelectric 40665852

12:M1-63 Smoke Detector 2 BY REST ROOM Photoelectric 40665853

12:M1-67 Smoke Detector 2 BY ROOM 234 Photoelectric 40665854

12:M1-68 Smoke Detector 2 BY ROOM 237 Photoelectric 40665855

12:M1-69 Smoke Detector 2 BY ROOM 239 Photoelectric 40665856

Kinetix 19 07/13/2018

12:M1-71 Smoke Detector 2 BY ROOM 243 Photoelectric 40665857

12:M1-72 Smoke Detector 2 BY ROOM 245 Photoelectric 40665858

12:M1-73 Smoke Detector 2 BY ROOM 230 Photoelectric 40665859

12:M1-75 Smoke Detector 1 BY REST ROOM Photoelectric 40665818

12:M1-76 Smoke Detector 1 BY ROOM 120 Photoelectric 40665819

MISC Elevator Ground Elevator 23 Recall Primary Recall 40665794

12:M1-03 Tamper Switch 1 East Exit 40665836

12:M1-04 Tamper Switch 1 RISER RM 41-101 OUTSIDE 40665837

Kinetix 20 07/13/2018

Building: Tampa VAMC Bldg 41 Control Panel: 1

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

12:M1-3-0 Tamper Switch 1 FL East Exit 41858079

17:M1-170-0 Tamper Switch 2FL Stairwell 2 41858076

6:M1-14-0 Tamper Switch BLDG Basement 41858075

6:M1-31-0 Tamper Switch 1 FL by stairwell 2 41858078

6:M1-31-0 Tamper Switch BLDG Basement 41858074

6:M1-31-0 Tamper Switch BLG32 Tunnel 41858077

12V-33Ah Battery Sealed Lead Acid 42020000

12V-33Ah Battery Sealed Lead Acid 42020001

For

Tampa VAMC Bldg 42

13000 Bruce B Downs Blvd

Tampa,FL 33637

Kinetix has performed this inspection and testing service in compliance with The Joint

Commission/VHA Standards. The inspection/testing frequencies adhered to for this service have been performed in accordance with The Joint Commission/VHA Memorandum 23 Concurrence on EC &

LS Standards effective September 2017. 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 Completion Date

Jun 13, 2018

Building: Tampa VAMC Bldg 42 Company: Kinetix

Building: Tampa VAMC Bldg 42 Contact: Darren Matteson

Address: 13000 Bruce B Downs Blvd Phone: 813-972-2000

Address: Fax:

City/State/Zip: Tampa, FL 33637 Mobile:

Country: United States of America Email:

Inspection Performed By

Company: Kinetix Inspector: Michael Gill

Address: 12 Creek Parkway Phone: 386-747-2294

Address: Fax: 3145020737

City/State/Zip: Boothwyn, PA 19061 Mobile:

Country: United States of America Email: michaelgill15@yahoo.com

Monitoring Company: Phone: Account #:

Central Station Signal Verification Type: Mfg: Model #:

Test Time/Date: Restore Time

Inspection Completion Date: Jun 13, 2018

Building: Tampa VAMC Bldg 42 and smoke detectors

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Duct Detector 6 6 0 6 0 6

Heat Detector 2 2 0 2 0 2

Pull Station 15 15 0 15 0 15

Smoke Detector 43 43 0 43 0 43 releasing devices

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Releasing Device 1 1 0 1 0 1

Speaker/Strobe 17 17 0 17 0 17

Strobe 2 2 0 2 0 2

EC 02.03.05 EP 19

Annual test of automatic smoke-detection shutdown devices for air-handling equipment per NFPA 90A-2018

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018)

Duct Detector 6 6 0 6 0 6

All other Life Safety Code fire alarm requirements related to NFPA 101-2018

18/19.3.4

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Battery 0 0 0 0 4 4

Total Device Count: 90

Company: Kinetix Building: Tampa VAMC Bldg 42

Building: Tampa VAMC Bldg 42 Control Panel: n/a

The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection.

ScanID Note Device Type Location Comment

EC 02.03.05 EP 03 Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

40665893 1 Duct Detector 1 1 FL By Room 42B-102 Passed

Shuts Down Unit

40665894 2 Duct Detector 1 Room 102 -42A (AHU Supply) Passed

Shuts Down Unit

40665917 3 Smoke Detector 1 1 FL Elevator Control Room Passed

Recalls To Primary Floor

40665939 4 Duct Detector 2 2 FL Room 42-218 ( AHU 92 Supply) Passed

Shuts Down Unit

40665940 5 Duct Detector 2 2 FL Room 42-215 ( AHU 94 Supply) Passed

Shuts Down Unit

40665941 6 Duct Detector 2 2 FL Room 202 ( AHU 98 Supply) Passed

Shuts Down Unit

40665942 7 Duct Detector 2 2 FLRoom 42-206 (AHU 97 Supply) Passed

Shuts Down Unit

40665950 8 Smoke Detector 2 2 FL Corridor By Elevator Passed

Recalls To Primary Floor

The Inspection & Testing section lists all of the items inspected in your building, which are then categorized by the applicable code reference. The most recent inspection is listed in the far right column and is based on the Finish Date of that inspection. The latest inspection uploaded in each previous quarter appears in the four columns to the left.

Passed=P, Failed=F, Replaced=R

EC 02.03.05 EP 03

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Test duct smoke detectors that use sampling tubes to ensure that they will properly sample the airstream in the duct using a method acceptable to the manufacturer or in accordance with their published instructions. (NFPA 72 Table 14.4.3.2 (17)(g)(5))

Duct Detector 6 6 0 6 6

Device Type Location ScanID Address Q2/17 Q2/18

Duct Detector 1 Room 102 -42A (AHU Supply) 40665894 0-21:M1-39 06/27-P 06/13-P

Duct Detector 1 1 FL By Room 42B-102 40665893 0-21:M1-32 06/27-P 06/13-P

Duct Detector 2 2 FLRoom 42-206 (AHU 97 Supply) 40665942 0-21:M1-12 06/27-P 06/13-P

Duct Detector 2 2 FL Room 42-218 ( AHU 92 Supply) 40665939 0-21:M1-04 06/30-P 06/13-P

Duct Detector 2 2 FL Room 42-215 ( AHU 94 Supply) 40665940 0-21:M1-08 06/27-P 06/13-P

Duct Detector 2 2 FL Room 202 ( AHU 98 Supply) 40665941 0-21:M1-11 06/27-P 06/13-P

Device Total: 6

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Restorable: Perform heat test with a listed and labeled heat source or in accordance with the manufacturer's published instructions. Non-

Restorable: Do not perform heat test. Test functionality mechanically and electrically. (NFPA 72 Table 14.4.3.2 (17)(d))

Heat Detector 2 2 0 2 2

Heat Detector 1 1FL ELEVATOR LOBBY 40665895 0-21:M1-71 06/27-P 06/13-P

Heat Detector 2 2FL ELEVATOR LOBBY 40665943 0-21:M1-57 06/27-P 06/13-P

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Operate manual fire alarm boxes per the manufacturer's published instructions. Test both key-operated presignal and general alarm manual fire alarm boxes. (NFPA 72 Table 14.4.3.2 (17e))

Pull Station 15 15 0 15 15

Pull Station 1 1 FL Room 42-119 40665901 0-21:M1-30 06/27-P 06/13-P

Pull Station 1 1 FL Room 42-117 40665902 0-21:M1-35 06/27-P 06/13-P

Pull Station 1 1 FL Room 42-123 40665900 0-21:M1-27 06/27-P 06/13-P

Pull Station 1 1 FL Room 42-112 40665904 0-21:M1-41 06/27-P 06/13-P

Pull Station 1 1 FL By Room 42-103 40665905 0-21:M1-42 06/27-P 06/13-P

Pull Station 1 1 FL Room 42-114 40665903 0-21:M1-38 06/27-P 06/13-P

Pull Station 1 1 FL By Room 42A-101 40665906 0-21:M1-46 06/27-P 06/13-P

Pull Station 1 1 FL Room 42A-105 40665907 0-21:M1-48 06/30-P 06/13-P

Pull Station 1 1 FL Room 42-127 40665899 0-21:M1-26 06/27-P 06/13-P

Pull Station 1 1 FL Room 42-130 40665898 0-21:M1-25 06/27-P 06/13-P

Pull Station 1 1 Fl Exitt By Room 42B-110 40665896 0-21:M1-18 06/27-P 06/13-P

Pull Station 1 1 FL Exit By Room 42B-101 40665897 0-21:M1-20 06/27-P 06/13-P

Pull Station 2 2 FL By East Stairwell 40665944 0-21:M1-02 06/27-P 06/13-P

Pull Station 2 2 FL Exit By Elevator 40665945 0-21:M1-06 06/27-P 06/13-P

Pull Station 2 2 FL By West Stairwell 40665946 0-21:M1-15 06/27-P 06/13-P

Device Total: 15

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Test smoke detectors in place to ensure smoke entry into the sensing chamber and an alarm response. (NFPA 72 Table 14.4.3.2 (17)(g)(1))

Smoke Detector 43 43 0 43 43

Smoke Detector 1 1 FL Elevator Control Room 40665917 0-21:M1-36 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42B-103 40665909 0-21:M1-21 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-133 40665911 0-21:M1-23 06/27-P 06/13-P

Smoke Detector 1 1 FLRoom 42-123 40665912 0-21:M1-28 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-124 40665913 0-21:M1-29 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-119 40665914 0-21:M1-31 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-117A 40665916 0-21:M1-34 06/27-P 06/13-P

Smoke Detector 1 1 FL Rear Electrical Room 40665915 0-21:M1-33 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42B-102 40665910 0-21:M1-22 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42A-102 40665921 0-21:M1-52 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-102 40665922 0-21:M1-53 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42A-105 40665920 0-21:M1-47 06/30-P 06/13-P

Smoke Detector 1 1 FL Room 42-110 40665918 0-21:M1-40 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-127 40665928 0-21:M1-66 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-106 40665925 0-21:M1-63 06/27-P 06/13-P

Smoke Detector 1 1 FLBy Room 42-109 40665923 0-21:M1-54 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-116 40665930 0-21:M1-68 06/27-P 06/13-P

Smoke Detector 1 ROOM 42B-102 40665924 0-21:M1-62 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-109 40665926 0-21:M1-64 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-123 40665929 0-21:M1-67 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-111 40665931 0-21:M1-69 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-110 40665932 0-21:M1-74 06/27-P 06/13-P

Smoke Detector 1 1 FL Room 42-105 40665919 0-21:M1-44 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42-128 40665927 0-21:M1-65 06/27-P 06/13-P

Smoke Detector 1 1 FL By Room 42B-110 40665908 0-21:M1-19 06/27-P 06/13-P

Smoke Detector 2 2 FL Fire Panel Room 42-218A 40665947 0-21:M1-01 06/28-P 06/13-P

Smoke Detector 2 2 FL Room 42-218 40665948 0-21:M1-03 06/27-P 06/13-P

Smoke Detector 2 2 FL Corridor By Elevator 40665950 0-21:M1-07 06/27-P 06/13-P

Smoke Detector 2 2 FLBy Room 42-211 40665951 0-21:M1-09 06/27-P 06/13-P

Smoke Detector 2 2 FLRoom 42-202 40665953 0-21:M1-13 06/27-P 06/13-P

Smoke Detector 2 2 FL By Room 42-202 40665952 0-21:M1-10 06/27-P 06/13-P

Smoke Detector 2 2 FLBy Room 42-205 40665954 0-21:M1-14 06/27-P 06/13-P

Smoke Detector 2 2 FL Storage Room 42-203 40665955 0-21:M1-16 06/30-P 06/13-P

Smoke Detector 2 2 FL Telephone Room 42-202E 40665956 0-21:M1-17 06/30-P 06/13-P

Smoke Detector 2 2 FL Storage Room 42-200 40665957 0-21:M1-24 06/27-P 06/13-P

Smoke Detector 2 2 FL By Room 42-221 40665949 0-21:M1-05 06/27-P 06/13-P

Smoke Detector 2 2 FL By Room 42-215 40665958 0-21:M1-50 06/30-P 06/13-P

Smoke Detector 2 2 FL By Room 42-205 40665959 0-21:M1-51 06/27-P 06/13-P

Smoke Detector 2 1 FL By Room 42-210 40665961 0-21:M1-58 06/27-P 06/13-P

Smoke Detector 2 1 FL Room 42-221 40665960 0-21:M1-56 06/30-P 06/13-P

Smoke Detector 2 ROOM 42-202 40665962 0-21:M1-59 06/27-P 06/13-P

Smoke Detector 2 1 FL Room 42-221 40665963 0-21:M1-60 06/27-P 06/13-P

Smoke Detector 2 1 FL Room 42-221 40665964 0-21:M1-78 06/27-P 06/13-P

Device Total: 43

Annual test of visual and audible fire alarms, including speakers and door releasing devices

Test interface equipment connections by operating or simulating the equipment being supervised. Verify signals required to be transmitted are received at the control unit. (NFPA 72 Table 14.4.3.2 (20))

Releasing Device 1 1 0 1 1

Releasing Device 1 AHU Shutdown AC 98 40665892 0 06/30-P 06/13-P

Annual test of visual and audible fire alarms, including speakers and door releasing devices

For periodic testing, verify the operation of the notification appliances. (NFPA 72 Table 14.4.3.2 (22)(b))

Speaker/Strobe 17 17 0 17 17

Speaker/Strobe 1 RM 124 BREAKROOM 40665890 0 06/30-P 06/13-P

Speaker/Strobe 1 RM 113 40665887 0 06/30-P 06/13-P

Speaker/Strobe 1 RM 102 40665886 0 06/30-P 06/13-P

Speaker/Strobe 1 BY RESTROOMS 40665885 0 06/30-P 06/13-P

Speaker/Strobe 1 BY B101 40665883 0 06/30-P 06/13-P

Speaker/Strobe 1 BY B110 40665884 0 06/30-P 06/13-P

Speaker/Strobe 1 RM A-105 40665891 0 06/30-P 06/13-P

Speaker/Strobe 1 RM 123 EAST 40665889 0 06/30-P 06/13-P

Speaker/Strobe 1 RM 119 40665888 0 06/30-P 06/13-P

Speaker/Strobe 1 BY A101 40665882 0 06/30-P 06/13-P

Speaker/Strobe 1 BY 109 40665881 0 06/30-P 06/13-P

Speaker/Strobe 2 BY 212 40665935 0 06/30-P 06/13-P

Speaker/Strobe 2 BY 215 40665936 0 06/30-P 06/13-P

Speaker/Strobe 2 BY 209 40665934 0 06/30-P 06/13-P

Speaker/Strobe 2 BY 220 40665937 0 06/30-P 06/13-P

Speaker/Strobe 2 By Room 205 40665938 0 06/30-P 06/13-P

Speaker/Strobe 2 Room 218 Exit 40665965 0 06/30-P 06/13-P

Device Total: 17

Annual test of visual and audible fire alarms, including speakers and door releasing devices

For periodic testing, verify that each appliance flashes. (NFPA 72 Table 14.4.3.2 (22c))

Strobe 2 2 0 2 2

Strobe 1 MENS 116 40665933 0 06/30-P 06/13-P

Strobe 2 WOMENS 115 40665966 0 06/30-P 06/13-P

Annual test of automatic smoke-detection shutdown devices for air-handling equipment per NFPA 90A-

Test duct smoke detectors that use sampling tubes to ensure that they will properly sample the airstream in the duct using a method acceptable to the manufacturer or in accordance with their published instructions. (NFPA 72 Table 14.4.3.2 (17)(g)(5))

Duct Detector 6 6 0 6 6

Duct Detector 1 Room 102 -42A (AHU Supply) 40665894 0-21:M1-39 06/27-P 06/13-P

Duct Detector 1 1 FL By Room 42B-102 40665893 0-21:M1-32 06/27-P 06/13-P

Duct Detector 2 2 FLRoom 42-206 (AHU 97 Supply) 40665942 0-21:M1-12 06/27-P 06/13-P

Duct Detector 2 2 FL Room 42-218 ( AHU 92 Supply) 40665939 0-21:M1-04 06/30-P 06/13-P

Duct Detector 2 2 FL Room 42-215 ( AHU 94 Supply) 40665940 0-21:M1-08 06/27-P 06/13-P

Duct Detector 2 2 FL Room 202 ( AHU 98 Supply) 40665941 0-21:M1-11 06/27-P 06/13-P

Device Total: 6

All other Life Safety Code fire alarm requirements related to NFPA 101-2018 18/19.3.4

With the batteries fully charged and connected to the charger, measure the voltage across the batteries with a voltmeter. Then, with the battery charger disconnected, load test the batteries following the manufacturer's recommendations. (NFPA 72 Table 14.4.3.2 (9))

Battery 0 0 0 0 4

Battery 2 Fire Alarm Panel 42020006 1-12V-12Ah 06/28-P

Battery 2 Fire Alarm Panel 42020007 1-12V-12Ah 06/28-P

Battery 2 Fire Alarm Panel 42020008 1-12V-33Ah 06/28-P

Battery 2 Fire Alarm Panel 42020009 1-12-33Ah 06/28-P

Device Total: 4

Duct Detector Tested 6

Heat Detector Tested 2

Pull Station Tested 15

Releasing Device Tested 1

Smoke Detector Tested/Cleaned 43

Speaker/Strobe Tested 17

Strobe Tested 2

Total 86

Untested Battery 4

Total 4

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

Passed

Duct Detector

Fan Shut Down 1 1 FL By Room 42B-102 Passed 40665893

Fan Shut Down 1 Room 102 -42A (AHU Supply) Passed 40665894

Fan Shut Down 2 2 FL Room 202 ( AHU 98 Supply) Passed 40665941

Fan Shut Down 2 2 FL Room 42-215 ( AHU 94 Supply) Passed 40665940

Fan Shut Down 2 2 FL Room 42-218 ( AHU 92 Supply) Passed 40665939

Fan Shut Down 2 2 FLRoom 42-206 (AHU 97 Supply) Passed 40665942

Heat Detector

Shunt Trip 1 1FL ELEVATOR LOBBY Passed 40665895

Shunt Trip 2 2FL ELEVATOR LOBBY Passed 40665943

Smoke Detector

Elevator Recall 1 1 FL Elevator Control Room Passed 40665917

Elevator Recall 2 2 FL Corridor By Elevator Passed 40665950

Releasing Device

1 AHU Shutdown AC 98 Passed 40665892

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

Battery Control 4.44% 4

Pull Station Initiating 16.67% 15

Heat Detector Initiating 2.22% 2

Releasing Device Auxiliary 1.11% 1

Smoke Detector Initiating 47.78% 43

Strobe Indicating 2.22% 2

Speaker/Strobe Indicating 18.89% 17

Duct Detector Initiating 6.67% 6

Type Qty Model # Description Install Date

In Service - 2 Years to 3 Years

Simplex

Duct Detector 6 Photoelectric 06/29/2016

Pull Station 10 06/29/2016

Smoke Detector 1 06/29/2016

Smoke Detector 37 Photoelectric 06/29/2016

Pull Station 4 06/16/2016

Releasing Device 1 06/16/2016

Smoke Detector 3 Photoelectric 06/16/2016

Speaker/Strobe 17 06/16/2016

Strobe 2 06/16/2016

Heat Detector 2 06/08/2016

Pull Station 1 06/08/2016

Smoke Detector 2 Photoelectric 06/08/2016

Building: Tampa VAMC Bldg 42 Control Panel: 1

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.

Type Qty Model # Description Install Date

In Service - 2 Years to 3 Years

Battery 4 Sealed Lead Acid 06/29/2016

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

21:M1-01 Smoke Detector 2 2 FL Fire Panel Room 42-218A Photoelectric 40665947

21:M1-02 Pull Station 2 2 FL By East Stairwell 40665944

21:M1-03 Smoke Detector 2 2 FL Room 42-218 Photoelectric 40665948

21:M1-04 Duct Detector 2 2 FL Room 42-218 ( AHU 92 Supply) Photoelectric 40665939

21:M1-05 Smoke Detector 2 2 FL By Room 42-221 Photoelectric 40665949

21:M1-06 Pull Station 2 2 FL Exit By Elevator 40665945

21:M1-07 Smoke Detector 2 2 FL Corridor By Elevator Photoelectric 40665950

21:M1-08 Duct Detector 2 2 FL Room 42-215 ( AHU 94 Supply) Photoelectric 40665940

21:M1-09 Smoke Detector 2 2 FLBy Room 42-211 Photoelectric 40665951

21:M1-10 Smoke Detector 2 2 FL By Room 42-202 Photoelectric 40665952

21:M1-11 Duct Detector 2 2 FL Room 202 ( AHU 98 Supply) Photoelectric 40665941

21:M1-12 Duct Detector 2 2 FLRoom 42-206 (AHU 97 Supply) Photoelectric 40665942

21:M1-13 Smoke Detector 2 2 FLRoom 42-202 Photoelectric 40665953

21:M1-14 Smoke Detector 2 2 FLBy Room 42-205 Photoelectric 40665954

21:M1-15 Pull Station 2 2 FL By West Stairwell 40665946

21:M1-16 Smoke Detector 2 2 FL Storage Room 42-203 Photoelectric 40665955

21:M1-17 Smoke Detector 2 2 FL Telephone Room 42-202E Photoelectric 40665956

21:M1-18 Pull Station 1 1 Fl Exitt By Room 42B-110 40665896

21:M1-19 Smoke Detector 1 1 FL By Room 42B-110 Photoelectric 40665908

21:M1-20 Pull Station 1 1 FL Exit By Room 42B-101 40665897

21:M1-21 Smoke Detector 1 1 FL By Room 42B-103 Photoelectric 40665909

21:M1-22 Smoke Detector 1 1 FL Room 42B-102 Photoelectric 40665910

21:M1-23 Smoke Detector 1 1 FL Room 42-133 Photoelectric 40665911

21:M1-24 Smoke Detector 2 2 FL Storage Room 42-200 Photoelectric 40665957

21:M1-25 Pull Station 1 1 FL Room 42-130 40665898

21:M1-26 Pull Station 1 1 FL Room 42-127 40665899

21:M1-27 Pull Station 1 1 FL Room 42-123 40665900

21:M1-28 Smoke Detector 1 1 FLRoom 42-123 Photoelectric 40665912

21:M1-29 Smoke Detector 1 1 FL Room 42-124 Photoelectric 40665913

21:M1-30 Pull Station 1 1 FL Room 42-119 40665901

21:M1-31 Smoke Detector 1 1 FL Room 42-119 Photoelectric 40665914

21:M1-32 Duct Detector 1 1 FL By Room 42B-102 Photoelectric 40665893

21:M1-33 Smoke Detector 1 1 FL Rear Electrical Room Photoelectric 40665915

21:M1-34 Smoke Detector 1 1 FL Room 42-117A 40665916

21:M1-35 Pull Station 1 1 FL Room 42-117 40665902

21:M1-36 Smoke Detector 1 1 FL Elevator Control Room Photoelectric 40665917

21:M1-38 Pull Station 1 1 FL Room 42-114 40665903

21:M1-39 Duct Detector 1 Room 102 -42A (AHU Supply) Photoelectric 40665894

21:M1-40 Smoke Detector 1 1 FL Room 42-110 Photoelectric 40665918

21:M1-41 Pull Station 1 1 FL Room 42-112 40665904

21:M1-42 Pull Station 1 1 FL By Room 42-103 40665905

21:M1-44 Smoke Detector 1 1 FL Room 42-105 Photoelectric 40665919

21:M1-46 Pull Station 1 1 FL By Room 42A-101 40665906

21:M1-47 Smoke Detector 1 1 FL Room 42A-105 Photoelectric 40665920

21:M1-48 Pull Station 1 1 FL Room 42A-105 40665907

21:M1-50 Smoke Detector 2 2 FL By Room 42-215 Photoelectric 40665958

21:M1-51 Smoke Detector 2 2 FL By Room 42-205 Photoelectric 40665959

21:M1-52 Smoke Detector 1 1 FL By Room 42A-102 Photoelectric 40665921

21:M1-53 Smoke Detector 1 1 FL By Room 42-102 Photoelectric 40665922

21:M1-54 Smoke Detector 1 1 FLBy Room 42-109 Photoelectric 40665923

21:M1-56 Smoke Detector 2 1 FL Room 42-221 Photoelectric 40665960

21:M1-57 Heat Detector 2 2FL ELEVATOR LOBBY 40665943

21:M1-58 Smoke Detector 2 1 FL By Room 42-210 Photoelectric 40665961

21:M1-59 Smoke Detector 2 ROOM 42-202 Photoelectric 40665962

21:M1-60 Smoke Detector 2 1 FL Room 42-221 Photoelectric 40665963

21:M1-62 Smoke Detector 1 ROOM 42B-102 Photoelectric 40665924

21:M1-63 Smoke Detector 1 1 FL By Room 42-106 Photoelectric 40665925

21:M1-64 Smoke Detector 1 1 FL By Room 42-109 Photoelectric 40665926

21:M1-65 Smoke Detector 1 1 FL By Room 42-128 Photoelectric 40665927

21:M1-66 Smoke Detector 1 1 FL Room 42-127 Photoelectric 40665928

21:M1-67 Smoke Detector 1 1 FL By Room 42-123 Photoelectric 40665929

21:M1-68 Smoke Detector 1 1 FL By Room 42-116 Photoelectric 40665930

21:M1-69 Smoke Detector 1 1 FL By Room 42-111 Photoelectric 40665931

21:M1-71 Heat Detector 1 1FL ELEVATOR LOBBY 40665895

21:M1-74 Smoke Detector 1 1 FL By Room 42-110 Photoelectric 40665932

21:M1-78 Smoke Detector 2 1 FL Room 42-221 Photoelectric 40665964

Building: Tampa VAMC Bldg 42 Control Panel: 1

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

12-33Ah Battery 2 Fire Alarm Panel Sealed Lead Acid 42020009

12V-12Ah Battery 2 Fire Alarm Panel Sealed Lead Acid 42020006

12V-12Ah Battery 2 Fire Alarm Panel Sealed Lead Acid 42020007

12V-33Ah Battery 2 Fire Alarm Panel Sealed Lead Acid 42020008

For

Tampa VAMC Bldg 53

13000 Bruce B Downs Blvd

Tampa,FL 33637

Kinetix has performed this inspection and testing service in compliance with The Joint

Commission/VHA Standards. The inspection/testing frequencies adhered to for this service have been performed in accordance with The Joint Commission/VHA Memorandum 23 Concurrence on EC &

LS Standards effective September 2017. 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 Completion Date

Jun 14, 2018

Building: Tampa VAMC Bldg 53 Company: Kinetix

Building: Tampa VAMC Bldg 53 Contact: Darren Matteson

Address: 13000 Bruce B Downs Blvd Phone: 813-972-2000

Address: Fax:

City/State/Zip: Tampa, FL 33637 Mobile:

Country: United States of America Email:

Inspection Performed By

Company: Kinetix Inspector: Michael Gill

Address: 12 Creek Parkway Phone: 386-747-2294

Address: Fax: 3145020737

City/State/Zip: Boothwyn, PA 19061 Mobile:

Country: United States of America Email: michaelgill15@yahoo.com

Monitoring Company: Phone: Account #:

Central Station Signal Verification Type: Mfg: Model #:

Test Time/Date: Restore Time

Inspection Completion Date: Jun 14, 2018

Building: Tampa VAMC Bldg 53

EC 02.03.05 EP 02

Semi-annual testing of water flow devices and valve tamper switches

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018)

Tamper Switch 0 0 0 2 0 2 and smoke detectors

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Duct Detector 4 4 0 4 0 4

Heat Detector 2 1 1 2 0 2

Pull Station 9 9 0 9 0 9

Smoke Detector 26 23 3 26 0 26 releasing devices

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Horn 20 20 0 20 0 20

Releasing Device 16 16 0 16 0 16

Speaker/Strobe 23 23 0 23 0 23

Annual test of automatic smoke-detection shutdown devices for air-handling equipment per NFPA 90A-2018

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018)

Duct Detector 4 4 0 4 0 4

Elevators are fully equipped and protected

Devices Tested This

Quarter Pass Fail

Tested YTD

(2018)

Untested YTD

(2018) Total Quantity

Elevator 1 1 0 1 0 1

Total Device Count: 103

Company: Kinetix Building: Tampa VAMC Bldg 53

Discrepancy Report

Building: Tampa VAMC Bldg 53 Control Panel: n/a

The Discrepancy Report consolidates each discrepancy listed within the various Testing sections of your Inspection.

Discrepancies are listed by Category, and grouped by device type. The description of the problem is provided and where appropriate, code references are listed for your convenience. Any item that was inspected that is listed on the Consumer

Product Safety Commission's website and is subject to a recall by the manufacturer is included.

Device Type Manufacturer ModelNumber Date Qty

Items listed for Recall by Manufacturer

No recalled items found during this inspection.

ScanID Location Problem Address Reference

EC 02.03.05 EP 03 Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Heat Detector

40666004 1 1 FL Elevator Equipment Room Failed Operation 0-14:M1-05 NFPA72 14.2.2.2.2

Smoke Detector

40666027 1 1 FL Elevator Equipment Room Failed Operation 0-14:M1-06 NFPA72 14.2.2.2.2

40666039 1 1 FL Elevator Lobby Failed Operation 0-14:M1-25 NFPA72 14.2.2.2.2

40666068 2 2 FL Elevator Lobby Failed Operation 0-14:M1-42 NFPA72 14.2.2.2.2

Code References NFPA72 14.2.2.2.2 System deficiencies shall be corrected.

Proposed Solutions Report

The Proposed Solution Report provides a solution for each discrepancy listed on the Discrepancy Report. Provide a check mark where indicated to approve repairs listed within the report. Items listed as T/M are available for repair on a

Time and Materials basis.

ScanID Location Solution Model # Cost Fix

EC 02.03.05 EP 03 Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Heat Detector

40666004 1 1 FL Elevator Equipment Room Investigate T/M

Smoke Detector

40666027 1 1 FL Elevator Equipment Room Investigate T/M

40666039 1 1 FL Elevator Lobby Investigate T/M

40666068 2 2 FL Elevator Lobby Investigate T/M

The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection.

ScanID Note Device Type Location Comment

EC 02.03.05 EP 03 Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

40666002 1 Duct Detector 1 1 FL Outside Mech. South Mech RM AHU Passed

Shuts Down Unit

40666003 2 Duct Detector 1 1 FL Outside Mech. North/ AHU 2 Passed

Shuts Down Unit

40666004 3 Heat Detector 1 1 FL Elevator Equipment Room Failed Operation

Did Not Shunt

40666027 4 Smoke Detector 1 1 FL Elevator Equipment Room Failed Operation

Did Not Recall

40666039 5 Smoke Detector 1 1 FL Elevator Lobby Failed Operation

Did Not Recall

40666053 6 Duct Detector 2 2 FL Mech. Rm AHU 3 Supply Passed

Shuts Down Unit

40666054 7 Duct Detector 2 2 FL Mech. Rm AHU 3 Return Passed

Shuts Down Unit

40666068 8 Smoke Detector 2 2 FL Elevator Lobby Failed Operation

Did Not Recall

The Inspection & Testing section lists all of the items inspected in your building, which are then categorized by the applicable code reference. The most recent inspection is listed in the far right column and is based on the Finish Date of that inspection. The latest inspection uploaded in each previous quarter appears in the four columns to the left.

Passed=P, Failed=F, Replaced=R

EC 02.03.05 EP 02

Semi-annual testing of water flow devices and valve tamper switches

Operate valve and verify signal receipt shall be verified to be within the first two revolutions of the hand wheel or within one-fifth of the travel distance, or per the manufacturer's published instructions. (NFPA 72 Table 14.4.3.2 (17)(j)(1))

Tamper Switch 0 0 0 2 2

Tamper Switch 1 1 FL Elevator Equipment Room 40666048 0-14:M1-04 01/12-P

Tamper Switch 1 1 FL Riser by FACP 40666047 0-14:M1-02 01/12-P

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Test duct smoke detectors that use sampling tubes to ensure that they will properly sample the airstream in the duct using a method acceptable to the manufacturer or in accordance with their published instructions. (NFPA 72 Table 14.4.3.2 (17)(g)(5))

Duct Detector 4 4 0 4 4

Duct Detector 1 1 FL Outside Mech. South Mech

RM AHU

40666002 0-14:M1-48 06/29-P 06/13-P

Duct Detector 1 1 FL Outside Mech. North/ AHU

40666003 0-14:M1-49 06/29-P 06/13-P

Duct Detector 2 2 FL Mech. Rm AHU 3 Supply 40666053 0-14:M1-46 06/29-P 06/13-P

Duct Detector 2 2 FL Mech. Rm AHU 3 Return 40666054 0-14:M1-47 06/29-P 06/13-P

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Restorable: Perform heat test with a listed and labeled heat source or in accordance with the manufacturer's published instructions. Non-

Restorable: Do not perform heat test. Test functionality mechanically and electrically. (NFPA 72 Table 14.4.3.2 (17)(d))

Heat Detector 2 1 1 2 2

Heat Detector 1 1 FL Kitchen 40666005 0-14:M1-18 06/29-P 06/13-P

Heat Detector 1 1 FL Elevator Equipment Room 40666004 0-14:M1-05 06/22-F 06/12-F

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Operate manual fire alarm boxes per the manufacturer's published instructions. Test both key-operated presignal and general alarm manual fire alarm boxes. (NFPA 72 Table 14.4.3.2 (17e))

Pull Station 9 9 0 9 9

Pull Station 1 1 FL Northwet Entrance 40666022 0-14:M1-37 06/29-P 06/13-P

Pull Station 1 1 FL Northeast Entrance 40666021 0-14:M1-36 06/29-P 06/13-P

Pull Station 1 1 FL Office @ Northwest

Entrance

40666023 0-14:M1-38 06/29-P 06/13-P

Pull Station 1 1 FL East Double Door Entrance 40666020 0-14:M1-35 06/29-P 06/13-P

Pull Station 1 1 FL Southeast Entrance 40666019 0-14:M1-34 06/29-P 06/13-P

Pull Station 1 1 FL Family Room 116 40666024 0-14:M1-39 06/29-P 06/13-P

Pull Station 1 1 FL Southwest Entrance 40666018 0-14:M1-33 06/29-P 06/13-P

Pull Station 2 2 FL Center Stairwell 40666064 0-14:M1-44 06/29-P 06/13-P

Pull Station 2 2 FL Attic Access 40666065 0-14:M1-45 06/29-P 06/13-P

Device Total: 9

Annual testing of duct detectors, heat detectors, manual fire alarm boxes, and smoke detectors

Test smoke detectors in place to ensure smoke entry into the sensing chamber and an alarm response. (NFPA 72 Table 14.4.3.2 (17)(g)(1))

Smoke Detector 26 23 3 26 26

Smoke Detector 1 1 FL Dining Room 114 40666034 0-14:M1-20 06/29-P 06/13-P

Smoke Detector 1 1 FL Corridor By Kitchen 40666033 0-14:M1-17 06/29-P 06/13-P

Smoke Detector 1 1 FL Southeast Entrance 40666032 0-14:M1-16 06/29-P 06/13-P

Smoke Detector 1 1 FL Dining Room 114 40666035…