SimLearn July21 FM200.pdf

Special Hazards Inspection Report

Customer: Date of Service:

Contact: Time:

Address: SR#:

Task#:

Phone: Inspector:

Email or Fax:

Voltage Serial # Ceiling Type Normal

Ambient Temp.

Nozzle Qty. Nozzle Type

120/24 870005 drop tile 72 2 360

Date Last Tested:

Number of Exits

Altitude

UKN 1.00

YES NO N/A

Notified

Notified

Notified

YES NO N/A

YES NO N/A YES NO N/A

Photo Ion Thermal

4 4

4 4

0 0

YES NO N/A 0 0

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

YES NO N/A

Room Integrity Visually Inspected

Have there been any changes in the occupancy classification, machinery or operations since the last inspection?

Have there been any changes or repairs to the fire protection systems since the last inspection?

Have you requested updated MSDS sheets for Class B Flammables and are they readily available?

2. General (To be answered by Customer)

1. Pre-Inspection

Scott Reed

US Government

Johnson Controls, Inc.

If a fire has occurred since the last inspection, have all damaged system components been replaced?

Are Class B Flammables stored in the hazard area?

18AH PowerPatrol 100%/100%

Release Devices Operable

Qty. Of Releasing Control(s)

Type Of Releasing Control cross zoned pull station

List addl. special layout info: (Time Delay, Cross-Zone etc.) below:

24 Vdc

Type Of Release

Qty. Of Release(s)

Qty. Of Release(s) Tested Normal

10. Releasing Controls

Solenoids Tested Normal

Pneumatic Actuators Tested Normal

Manual Cylinder Actuators Tested Normal

Initiator Circuits Tested Normal

*Expiration Dates of Solenoids or Initiators

5. Control Panel Status

Input Alarm Circuits Tested Normal

7. Manual Release Stations

Type Of Equipment Shutdown

Type Of HVAC Shutdown

11. Post Inspection

System Reset For Normal Operation

System Tagged

System Tagged (Red/Green/Other)

Pressure Switches Installed

Dampers Installed & Operable

Qty. Of Abort Switches

Notification Devices Operate. As Designed

Instructional Signs Installed at Each Device

Quantity Of Notification Devices

Alarms Reported To Monitoring Co.

Function Of Pressure Switch:

Break Rods Intact

Abort Switches Tested Normal

Battery Load Tested Normal

Record Battery Voltage & Amp Hours

Time Delay In Seconds

Manual Release Overides Abort Tested

Design Concentration %

9. Auxillary Controls

Equipment Power Shutdown Installed

HVAC Shutdown Installed

30 seconds

Qty. Detectors Sensitivity Tested this Inspection

Scott.Reed@va.gov, Dalton.Allison@va.gov

2 A/V, 2 BELLS, 1 STROBE

Date Of Last Sensitivity Test UKN

UKN

Detectors Cleaned

Date Of Last Detector Cleaning

Other: (Air Sampling, Fus. Links, Pneumatic etc.)Output Alarm Circuits Tested Normal

Supervisory Circuits Tested Normal

Time Delay Tested Normal

Battery Back-up Voltage Normal

Charge Circuit Tested Normal

Active Zones Indicated

Inactive Zones Indicated

Battery Back-up Present

Qty. Of Detectors Tested At Last Inspection

Semi-Annual Inspection (per EP14 and NFPA2001 ver.2014)

Manufacturer

Ansul

Model

Job Site Contact Name:

Fire Marshall/AHJ Name:

Monitoring Company Name:

Proper Signage

Room Integrity Tested Main & ReserveDeck to DeckSubfloor Volume of Hazard (LxWxH)

SYSTEM TYPE

IQ-318

Area of Hazard (LxW)

08/10/21

Warren Shipley

Are Sequence of Operations Available and On-Site

Are As-Builts Available and On-Site

Address

City, State, Zip

Phone#

49759330

8:00

VA Lake Nona - SimLearn

Scott Reed, Dalton Allison

13800 Veterans' Way

Orlando, FL 32827

Additional Comments:

Indicator Lights Operational

Trouble Light Operable

78652923

6. Detection

Qty. Of Detectors

Johnson Controls Fire Protection LP

(321)689-7924, (321) 246-1157

3. Control Panel Status (pre-test)

Panel Monitored

Power Light Operable

Panel Indicator On Normal verify cylinder discharge

YELLOW

Type Of Damper servers

AHU controlled by main FACP

8. Notification Devices

Notification Devices Tested Normal

Qty. Detectors Tested Normal This Inspection

Silence Switch Operable

4. Piping/distribution System

Hazard Area Clean / Orderly

As-built Drawings On Site

Piping Secure & Clear of Debris

Hoses Inspected

Date Of Last Hose Test:

Yes No

AM PM

CO2 FM200 Sapphire Inergen Halon Other: (Indicate) Inspection Renovations Recharge

Yes No Yes No Yes No Yes No N/A

Yes No N/A

DEFICIENCIES

jshiplw Highlight

Customer: Date of Service:

Inspector: SR#:

Task#:

# Cylinder type Cylinder Mfr.

Serial

Number Last Test

Date Stamped Wt. (A)

Total Wt. (B) Cylinder Fill / Capacity (A-

B)

Cylinder Pressure

Condition Liquid Level

Indicator Temperature

Last 5 Yr.

External

Inspection Date

Rack #

1 4BW450 ANSUL ATM629548 16-May 466.4 201.6 264.8 360 GOOD 55cm 72

Scott Reed, Dalton Allison

Print Name:

8/10/2021

Inspector Name (Print):

Warren H. Shipley

8/10/2021

Signature:

emailed to Scott.Reed@va.gov, Dalton.Allison@va.gov

IMPORTANT NOTICE TO CUSTOMER: Customer acknowledges and agrees that, in the absence of a Service Agreement between parties, services hereunder are performed pursuant to the terms and conditions on the reverse side of this Inspection Report. Customer further agrees that the services have been completed to Customer's satisfaction and that the system is in good working order and repair, unless services performed were of a temporary nature, in which case Customer acknowledges that part of customer's system may have been bypassed or is otherwise inoperable until services can be completed. CUSTOMER'S ATTENTION IS DIRECTED TO THE LIMITATION OF LIABILITY, WARRANTY, INDEMNITY AND OTHER CONDITIONS ON THE REVERSE SIDE.

Acceptance of customer or customer's representative

Date:Inspector Signature:Date:

15. Deficiencies and Recommendations were discussed with Customer / Customer Representative:

If No, explain:

Ceiling needs to be completely closed and sealed

14. Deficiencies and Recommendations:

Address

City, State Zip

Phone#

Repeat deficiencies from previous inspections.

Special Hazards Inspection Report Johnson Controls Fire Protection LP

Missing Sequence of Operations at panel and by entry door

Missing signs for 1st alarm (BELL), 2nd alarm (A/V cadence), agent discharged (A/V continous, and STROBE only flashing)

8/10/21

49759330

78652923 Warren Shipley

VA Lake Nona - SimLearn

12. Cylinder Inspection

Cylinder Inspection Comments:

Good condition

13. List Changes in Occupancy, Hazard, or Fire Protection System in Section 2:

Yes No N/A jshiplw Highlight jshiplw Highlight jshiplw Highlight jshiplw Highlight

TERMS AND CONDITIONS

1. Limitation of Liability; Limitations of Remedy. It is understood and agreed by Customer that Company is not an insurer and that insurance coverage shall be obtained by Customer and that amounts payable to Company hereunder are based upon the value of the services and the scope of liability set forth in this agreement and are unrelated to the value of Customer’s property and the property of others located on the premises. Customer agrees to look exclusively to Customer’s insurer to recover for injuries or damage in the event of any loss or injury, and Customer releases and waives all right of recovery against Company arising by way of subrogation. Company makes no guaranty or warranty, including any implied warranty of merchantability or fitness for a particular purpose that equipment or services supplied by Company will detect or avert occurrences or the consequences therefrom that the equipment or service was designed to detect or avert.

It is impractical and extremely difficult to fix the actual damages which may proximately result from failure on the part of Company to perform any of its obligations under this agreement. Accordingly, Customer agrees that, Company shall be exempt from liability for any loss, damage or injury arising directly or indirectly from occurrences, or the consequences therefrom, which the equipment or service was designed to detect or avert. Should Company be found liable for any loss, damage or injury arising from a failure of the equipment or service in any respect, Company’s liability shall be limited to an amount equal to the agreement price (as increased by the price for any additional work) or where the time and material payment term is selected, Customer’s time and material payments to Company. Where this agreement covers multiple sites, liability shall be limited to the amount of the payments allocable to the site where the incident occurred. Such sum shall be complete and exclusive. IN NO EVENT SHALL COMPANY BE LIABLE FOR ANY DAMAGE, LOSS, INJURY, OR ANY OTHER CLAIM ARISING FROM ANY SERVICING, ALTERATIONS, MODIFICATIONS, CHANGES, OR MOVEMENTS OF THE COVERED SYSTEM(S) OR ANY OF ITS COMPONENT PARTS BY CUSTOMER OR ANY THIRD PARTY. COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO DAMAGES ARISING FROM LOSS OF USE OR LOST PROFITS. The limitations of liability set forth in this agreement shall inure to the benefit of all parents, subsidiaries and affiliates of Company, whether direct or indirect, Company’s employees, agents, officers and directors.

2. Limited Warranty. COMPANY WARRANTS THAT ITS WORKMANSHIP AND MATERIAL FURNISHED UNDER THIS AGREEMENT WILL BE FREE FROM DEFECTS FOR A PERIOD OF NINETY (90) DAYS FROM THE DATE OF FURNISHING. Where Company provides product or equipment of others, Company will warrant the product or equipment only to the extent warranted by such third party. EXCEPT AS EXPRESSLY SET FORTH HEREIN, COMPANY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE SERVICES PERFORMED OR THE

PRODUCTS, SYSTEMS OR EQUIPMENT, IF ANY, SUPPORTED HEREUNDER.

3. Indemnity. Customer agrees to indemnify, hold harmless and defend Company against any and all losses, damages, costs, including expert fees and costs, and expenses including reasonable attorneys’ fees, arising from any and all third-party claims for personal injury, death, property damage or economic loss, resulting from any act or omission of Customer or Company, including without limitation damages resulting from the exposure of workers to Hazardous Conditions whether or not Customer pre-notifies Company of the existence of said Hazardous Conditions, whether such claims are based upon contract, warranty, tort (including but not limited to active or passive negligence), strict liability or otherwise. Company reserves the right to select counsel to represent it in any such action.

4. Hazardous Materials. Customer represents that, except to the extent that Company has been given written notice of the following hazards prior to the execution of this agreement, to the best of Customer’s knowledge there is no:

• “permit confined space,” as defined by the Occupational Safety and Health Administration (“OSHA”);

• risk of infectious disease,

• need for air monitoring, respiratory protection, or other medical risk; or

• asbestos, asbestos-containing material, formaldehyde or other potentially toxic or otherwise hazardous material contained in or on the surface of the floors, walls, ceilings, insulation or other structural components of the area of any building where work is required to be performed under this agreement.

All of the above are hereinafter referred to as “Hazardous Conditions.” Company shall have the right to rely on the representations listed above. If Hazardous Conditions are encountered by Company during the course of Company’s work, the discovery of such materials shall constitute an event beyond Company’s reasonable control, and Company shall have no obligation to further perform services in the area where the Hazardous Conditions exist until the area has been made safe by Customer as certified in writing by an independent testing agency. Customer shall pay disruption expenses and re-mobilization expenses as determined by Company. This agreement does not provide for the cost of capture, containment or disposal of any hazardous waste materials, or hazardous materials encountered during performance of the services. Said materials shall at all times remain the responsibility and property of Customer. Company shall not be responsible for the testing, removal or disposal of such hazardous materials.

5. Equipment Disconnections. This represents Company’s notice to you that the systems/equipment/devices listed on the face of this agreement as temporarily or permanently disconnected are no longer in service and, thus, cannot detect, perform and/or report occurrences or transmit signals. During any period of impairment, in the event of any occurrence which the fire protection system was designed to detect or avert, Customer agrees to defend, indemnify and hold Company harmless from any and all claims arising out of or related to or resulting from that occurrence, including any claims arising out of the impaired condition of the system and/or the cause of such impairment.

6. General. Unless otherwise specified, work shall be done between the hours of 8:00 AM and 5:00 PM, exclusive of Saturdays, Sundays and Company holidays. All work is subject to review and rebilling in accordance with the terms and conditions of Customer’s agreement/contract with Company, if one is in effect. Company shall not be responsible for failure to render services due to causes beyond its reasonable control, including but not limited to material shortages, work stoppages, fires, civil disobedience or unrest, severe weather, fire or any other cause beyond the control of Company. Customer is aware that the Limitation of Liability and other provisions set forth in any existing agreement/contract, if one is in effect, or set forth above, apply to services performed and materials supplied. The terms of this agreement shall govern notwithstanding any inconsistent or additional terms and conditions in any purchase order or other document submitted by Customer.

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