FY 2024 Annual Fire Alarm Bldg 9.pdf

Inspection and Test Report

Date: October 16, 2023 Time: 8:00am Tag Color: Green

Service Organization Location

Name: Alexandria VA Fire Department Customer: Building 9

Address: 2495 Shreveport Hwy Property: Alexandria VA Health Care System

Pineville, LA

ZIP Code 71360

Monitoring Company

Contact: Alexandria VA Fire Department

Telephone: 318-466-2718

Transmission Type

Address: 2495 Shreveport Hwy

Pineville, LA 71360

Contact: Joel Miller Fire Chief

Telephone: (318) 466-4313

Service Frequency

McCulloh Weekly

Multiplex Monthly

X Digital Quarterly

Reverse Polarity Semi-Annual

RF X Annual

Other: Other:

Control Panel Manufacturer: Edwards (ETS)

Number of Initiating Circuits: 2 (A & B)

Software Version Number: V4.0

Last Date System Had Any Service Performed:

Model No.: Fire Work System

Circuit Styles A & B Fiber

Last Date Software or Configuration Was Change(

Alarm Initiating Device and Circuit Information

Quantity Quantity Circuit Installed Tested Styles Device Type

18 18 2 Manual Pull Station

Air Sampling Smoke Detector

Ionization Smoke Detector 27 27 2 Photoelectric Smoke Detector

Photoelectric Beam Detector

Ionization Air Duct Smoke Detector

Photoelectric Air Duct Smoke Detector

Fixed Temperature Heat Detector

2 2 2 Rate of Rise Heat Detector

Rate Compensated Heat Detector

Line Type Heat Detection Cable

7 7 2 Fire Sprinkler Waterflow Switch

Other:

Alarm Verification feature is DISABLED 0 ENABLED 0

Alarm Notification Appliances and Circuit Information

Quantity Quantity Circuit Installed Tested Styles Device Type

0 Bells

0 Horns

0 Chimes

0 Speakers

0 Strobe Lights

125 125 Y Other: Combination Horn/Strobe

Number of Alarm Indicating Circuits: 6

Are Circuits Monitored for Integrity? X Yes No

Supervisory Signal Initiating Devices and Circuit Information

Quantity Quantity Circuit Installed Tested Styles Device Type

13 13 2 Tamper Switch

Building Temperature

Site Water Level

2 2 2 Fire Pump Power

1 1 2 Fire Pump Running

Fire Pump Auto Position

Fire Pump or Controller Trouble

7 7 2 Main Drain

4 4 Fire Department Connections

9 9 2 Transfer Switch/Control Relays

Generator Engine Running

Low Air Pressure

12 12 2 Air Duct Smoke Detector

Other:

Signaling Line Circuits

Quantity: 1 Circuit Style: 6

System Power Supplies a.Primary: Nominal Voltage 120 Amps 1

Overcurrent Protection: Type: Circuit Breaker Amps 20

Location of Primary Supply Panelboard: Elec Closet Room 122B Panel "E9GN"

Power Disconnect Location: Breaker #16 & 18 b.Secondary (Standby)

Sealed Lead Acid Storage Battery: Amp- Hour Rating: 8 AH

Calculated capacity is Amp-Hours to operate the system for 24 Hours

Engine driven generator dedicated to the fire alarm system

Location of fuel storage:

Battery Type

Dry Cell Lead Acid

Nickel- Cadmium Other:

X Sealed Lead Acid

c. Emergency or standby system used as a backup to primary power supply instead of using a secondary power supply:

Emergency system described in NFPA 70, Article 700

Legally required standby system described in NFPA 70, Article 701

Optional Standby System described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701

PRIOR TO ANY TESTING

NOTIFICATIONS ARE MADE:

Monitoring Company

Building Occupants

Building Management

Other

AHJ Notified of Any Impairments

Yes x x x

No Who & Time

VA Fire Department 1332

Joel Miller Fire Chief

SYSTEM TESTS AND INSPECTIONS

TYPE Visual Functional Comments

Control Panel

Interface Equipment

Lamp / LED's

Fuses

Primary Power Supply

Trouble Signals

Disconnect Switches

Ground Fault Monitoring

-iC x x x x

SECONDARY POWER

Battery Condition

Load Voltage

Discharge Test

Charger Test

N

See battery calc sheet for size requirements

Specific Gravity

X

TRANSIENT SUPPRESSORS

REMOTE ANNUNCIATORS

NOTIFICATION APPLIANCES

Audible

Visual

X _

Speakers

N/A

Voice Clarity

N/A

INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS

See attached initiating and supervisory device test report

Visual Device

Operation Simulated Operation

COMBINATION SYSTEMS

Time: 12:00 AM

THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS

Name of Inspector: Date: 16-Oct-23

EMERGENCY COMMUNICATIONS EQUIPMENT

Phone Set

Phone Jacks

Off-Hook Indicator

Amplifier(s)

Tone Generator(s)

Call-in Signal

System Performance

Functional Comments

INTERFACE EQUIPMENT

SPECIAL HAZARD SYSTEMS

Special Procedures

Comments:

SUPERVISING STATION MONITORING

Alarm Signal

Alarm Restoration

Trouble Signal

Trouble Restoration

Supervisory Signal

Supervisory Restoration

NOTIFICATION THAT TESTING IS COMPLETE

Building Management

Monitoring Company

Building Occupants

Other

Yes

No Time Comments

X

Yes

X

No

Who

Joel Miller Fire Chief

Time

Alexandria VA Fire Departmer

The following did not operate correctly:

System restored to normal operation: Date: 16-Oct-23 Time:

Signature:

Name of Owner or Representative: Joel Miller Fire Chief Date: 16-Oct-23 Time: 12:00 AM

Signature:

Visual

Fire Extinguisher Monitoring Device! System

Carbon Monoxide Detector / System

Other:

Protected Property: Alexandria VA Health Care System Address: 2495 Shreveport Hwy

Date: October 16, 2023 City: Pineville

State: Louisiana Zip 71360

Amps X 24 Hours

- Standby Amp-Hours

I

Amps X 0.083 5 Minutes 24 4 (5/60)

Alarm Amp-Hours

Secondary Standby Load

The Amount of Power that must be Supplied by the Batteries During Non- Alarm Conditions

Secondary Alarm Load

The Amount of Power that must be Supplied by the Batteries During Alarm Conditions

Battery Load Calculations 10/16/2023

Bldg 9 2495 Shreveport Hwy Pineville, LA 71360

Fire Detection

Total Secondary Load

Compensation for Non-Linear Discharge Characteristics X 1.20 Total Ampere Hour Battery Supply Required

Note: The loads shown above were determined by use of a current meter using actual field conditions.

Battery life tests 10/16/2023

Batteries Main Panel Batteries

Left

Right disposition volts

Amps volts

Amps 8Ah 12.7

11Ah 12.64

12Ah Good

Impairments 10/16/2023

Supervisory Signals 10/16/23 10/16/23

ANNUAL

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

EC .02.03.05 EP 1 Joint Commision Environment Of Care Detail Report-

Inspections Performed By Veterans Adminstation Fire Department (VAFD)

F r rir The Joint Commission

VA Fire Department

EC .02.03.05 EP 1

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Date Tested Device Type Building Floor Location Zone No. Notes Performed Result me o Alarm

Notification

I IA 1 st Fire Pump House AC Failure Tested Passed 5 Seconds

I IA 1st Fire Pump House Pump Running Tested Passed 5 Seconds

I IA 1st Fire Pump House

Phase Reversal Tested Passed 5 Seconds

Supervisory Signals

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended Frequency/Type of Inspection Total Devices In Inventory ir The Joint Commission

VA Fire Department Duct bct,ciors (DM»

EC .02.03.05 EP 3 & 19

ANNUAI, NFPA Standards NFPA 72, 2021

NFPA 72, 2010

Joint Commision Environment Of Care Detail Report- EC .02.03.05 EP 3 & 19

Test Result

Duct Detectors (DSD)

Date Tested Device Type Building Cust

Floor Location Zone No.

Comments

Notes Service

Performed 10/16/23 DSD 9 1st AHU Duct Detector Room 134 43020014

Tested Passed 10/16/23 DSD 9 1st AHU Duct Detector Room 124 43020015

10/16/23 DSD 9 2nd AHU Duct Detector Room 218 43020016

10/16/23 DSD 9 2nd AHU Duct Detector Room 202 43020017

10/16/23 DSD 9 2nd AHU Duct Detector Room 201 43020018

10/16/23 DSD 9 2nd AHU Duct Detector Room 201 43020019

10/16/23 DSD 9 3rd Center AHU Duct Detector RM 315 43020024

10/16/23 DSD 9 3rd Center AHU Duct Detector in Lobby 43020026

10/16/23 DSD 9 Attic North AHU Duct Detector AC1 43020020

10/16/23 DSD 9 Attic North AHU Duct Detector AC3 Supply 43020021

10/16/23 DSD 9 Attic Center AHU Cuct Detector AC3 Return 43020022

10/16/23 DSD 9 Attic South AHU AHU Duct Detector AC3 43020023 rpyr VP The Joint Commission

Facility Name Builtling 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Smoke Deteciors IPSD)

10/16/23 10/16/23

ANNUAL

EC .02.03.05 EP 3

NFPA Standards NFPA 72, 2021

NFPA 72, 2010

Joint Commision Environment Of Care Detail Report- EC .02.03.05 EP 3

Date Tested Device Type Building

Smoke Floor

Detectors PSD

Cust Zone No.

Comments

Notes Service

Performed Test

Result Location 10/16/23 PSD 9 1st Coorodor above FACP 43020001

10/16/23 PSD 9 1st Center Elveator Lobby 43020002

10/16/23 PSD 9 1st Center Door by Cooridor RM 135 43020003

10/16/23 PSD 9 1st North Door by RM 134 43020004

10/16/23 PSD 9 1st BLD 9 FL1 CENTER AHU DUCT DET IN ROOM 134 43020014

10/16/23 PSD 9 1st BLD 9 FL1 CENTER AHU DUCT DET OFFICE 124 43020015

10/16/23 PSD 9 1st Center in IRM Closet RM 119 43020029

10/16/23 PSD 9 2nd Center Elevator Lobby 43020006

10/16/23 PSD 9 2nd Center by RM 218 43020007

10/16/23 PSD 9 2nd North By RM 217 43020008

10/16/23 PSD 9 2nd BLD 9 FL2 CENTER AHU DUCT DET IN ROOM 218 43020016

10/16/23 PSD 9 2nd BLD 9 FL2 CENTER AHU DUCT DET IN ROOM 202 43020017

10/16/23 PSD 9 2nd BLD 9 FL2 NORTH AHU DUCT DET IN ROOM 201 43020018

10/16/23 PSD 9 2nd BLD 9 FL2 NORTH AHU DUCT DET IN ROOM 201 43020019

10/16/23 PSD 9 2nd Center by Med RM 200A 43020027

10/16/23 PSD 9 2nd Center in IRM Closet RM 219 43020030

10/16/23 PSD 9 3rd Center Elevator Lobby 43020009

10/16/23 PSD 9 3rd Center by RM 315 43020010

10/16/23 PSD 9 3rd North By RM 314 43020011

10/16/23 PSD 9 3rd BLD 9 FL3 CENTER AHU DUCT DET IN ROOM 315 43020024

10/16/23 PSD 9 3rd Center by Med RM 300A 43020028

10/16/23 PSD 9 3rd Center in IRM Closet RM 316 43020031

10/16/23 PSD 9 Attic Attic Center Top of Shaft 43020013

10/16/23 PSD 9 Attic BLD 9 ATTIC NORTH AHUDUCT DET ON UNIT AC1 43020020

10/16/23 PSD 9 Attic BLD 9 ATTIC CENTR AHUDUCT DET AC3 SUPPLY 43020021

10/16/23 PSD 9 Attic BLD 9 ATTIC CENTR AHUDUCT DET AC3 RETURN 43020022

10/16/23 PSD 9 Attic BLD 9 ATTIC SOUTH AHUDUCT DET AC2 43020023

Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection

Pull Stations

The Joint Commission

ANNUAL

NFPA Standards NFPA 72, 2021

Ref NFPA 72, 2010 It

Joint Commision Environment Of Care Detail Report-

Date Tested Device Type Building Floor

Cust Zone No.

Comments Notes

Service Performed

Test

10/16/23 PS 9 1st Center by RM 127 43020139

10/16/23 PS 9 1st North by RM 112 43020144

10/16/23 PS 9 1st By stairwell 1 43020145

10/16/23 PS 9 1st By RM 122 Exit 43020146

10/16/23 PS 9 1st Cooridor by FACP 43020147

10/16/23 PS 9 1st By stairwell #2 43020148

10/16/23 PS 9 1st Cooridor By RM 134 43020149

10/16/23 PS 9 1st By Stairwell #3 43020150

10/16/23 PS 9 1st By RM 118 Exit 43020151

10/16/23 PS 9 1st South Stairwell #1 43020152

10/16/23 PS 9 2nd Center by waiting room 43020128

10/16/23 PS 9 2nd Center By Stairwell #2 43020154

10/16/23 PS 9 2nd North By Stairwell #3 43020155

10/16/23 PS 9 3rd South By Stairwell #1 43020156

10/16/23 PS 9 3rd Center By stairwell #2 43020157

10/16/23 PS 9 3rd Cooridor By RM 314 43020158

10/16/23 PS 9 3rd North By Stairwell #3 43020159

10/16/23 PS 9 Attic By stairwell #2 43020160

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Inspections Performed By Veterans Adminstation Fire Department (VAFD) rr The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection

Control Relays

Date Tested Device Type

Joint

Building

Commision

Floor

Environment Of Care Detail Report-

Control Relays

EC .02.03.05

Cust Zone No.

EP 3

Comments Notes

Service Performed

Test

10/16/23 CR 9 1st BLD 9 FL1 CENTER SMOKE DOOR HOLDER RLY 43020127

10/16/23 CR 9 1st BLD 9 FL1 CENTER RLY FOR DOOR RELEASE 43020188

10/16/23 CR 9 2nd BLD 9 FL2 CENTER RLY AT LOBBY SMOKE DOORS 43020132

10/16/23 CR 9 2nd BLD 9 FL2 CENTER RLY2AT LOBBY SMOKE DOORS 43020133

10/16/23 CR 9 2nd BLD 9 FL2 CENTER RLY FOR DOOR RELEASE 43020189

10/16/23 CR 9 3rd BLD 9 FL3 CENTER SMOKE DOOR HOLDER RLY 43020136

10/16/23 CR 9 3rd BLD 9 FL3 CENTER RLY FOR DOOR RELEASE 43020190

10/16/23 CR 9 Attic BLD 9 ATTIC CENTER AHU SHTDWN UNIT AC3 43020140

10/16/23 CR 9 Attic BLD 9 ATTIC SOUTH AHU SHTDWN UNIT AC2 43020141 r The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Strobes/ Speaker Strobes

10/16/23 10/16/23

ANNUAL _

NFPA Standards NFPA 72, 2021

Joint Commision Environment Of Care Detail Report- EC .02.03.05 EP 3

Building

Strobes/ Speaker Strobes Cust

Zone No.

Comments

Notes Service

Performed Test

Result Date Tested Device Type Floor Location 10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 111

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST OUTSIDE ROOM 113

YJULt-Illtla

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 114

-1GLILIVJ

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 110

...t.A.A.P-1.

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST CORRIDOR

YOl./LL/A.A./.-/

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST OUTSIDE ROOM 115A

..-VA.A.A.I

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST OUTSIDE ROOM 115D

.-1,,./Ll/l/l.//

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST OUTSIDE WEST STAIRWELL

Y.-A./at-ILA-KJ

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 116

YJVGLILIVJ

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST MALE STAFF LOCKER ROOM

Y.-A-ICI-MIL/ I 1./

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST MALE STAFF LOCKER BATHROOM

Y.-A./LI/VI./ I I

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST MALE STAFF LOCKER BATHROOM

../l/Ll/l/l/ I L

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 117

YJn.,,J I J

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST FEMALE STAFF LOCKER ROOM

Yi....-/l/

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST FEMALE STAFF LOCKER BATHROOM

4,-Illalltll/ I J

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST FEMALE STAFF LOCKER BATHROOM

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 108

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST OUTSIDE ROOM 108

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 118

,JUGLIIN I ../

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 107

Y.-P./Lk/LK/4,J

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 105

YJLIGLAJJC- I

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM G121A

,•./l/Ll/lIl-/LL

10/16/23 SO/SV 9 1st BLD 9 FL1 WEST ROOM 120

VOL/Lill/L/C,/

,,./l/Ll /C/C/L, 10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER ROOM 104

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER ROOM 101

Y.../WLVV,./L /

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER OUTSIDE ROOM 101

,JUGUIJULLI

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER ELEVATOR LOBBY

,JULLIVVJU

,JULVillIJ I

,,,./t-,../L

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER VISITOR WAITING AREA

.1 Jt. IGLIVVJJ

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER ROOM G122

YOVLVVV,P -1'

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER ROOM G122

,JLILLIAJLIJJ

10/16/23 SO/SV 9 1st BLD 9 FL1 CENTER NORTH STAIRWELL

,J,ILI.Illl1,11-1

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST OUTSIDE ROOM 134

4,../l/Li/l/l/t-f I

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 124A

,, ./l/011

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 124B

',Al C-VVVJJ

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 124E

•-1,./l/Gl/l/I,tl/ prov The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Strobes/ Speaker Strobes

10/16/23 10/16/23

ANNUAL

NFPA Standards NFPA 72, 2021

Strobes/ Floor

Speaker Strobes Cust

Zone No.

Comments

Notes Service

Performed Test

Result Location 10/16/23 SO/SV 9 1st BLD 9 FL1 EAST OUTSIDE ROOM 131

.-1,./VGVVVY I

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST OUTSIDE ROOM 129

YJN.Ial.IVVY a

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 127

, A, lalIlll,l, 10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 128

YJVLVVVY,

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST LOBBY AREA 126

.-1,1V.VVVY,

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 125

. ..A./4. VVVYV

.-..JVL V UV, /

•-,..),./LVVVYU

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 125C

. ..A. I all lll,l, 10/16/23 SO/SV 9 1st BLD 9 FL1 EAST ROOM 125B

.-1,1V.VVVJV

10/16/23 SO/SV 9 1st BLD 9 FL1 EAST STAIRWELL

, OW-LA./V..1 I

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST STAIRWELL

.-1, ..1.- I a

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST WING HALLWAY

.1,1,JalJi-lt-10.-1

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST WING HALLWAY

'YOU CUL, I ...I,

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 232

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10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 232

•-h-JVC.VVV../V

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 232A

Y.-1,,,JVV../ /

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST OUTSIDE ROOM 222

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10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 233

,•-, all1.11. I ...I J

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YOlIGLIA-1,11-1, 10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 234

YOWLVV1-1‘.1,

10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST ROOM 221

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10/16/23 SO/SV 9 2nd BLD 9 FL2 WEST OUTSIDE ROOM 220

YJVal.A.A.11.), 10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER WING HALLWAY

4,211-lallt,./VJ

YIJVC.VVVVU

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Y011al),,,Ill

10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER ROOM 236

',JUGlltIlll.1, 10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER ROOM 243 BATHROOM

.1,..fULVV,./ 1 tl

10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER ROOM 243 BATHROOM

.....VVV I I

10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER ROOM 240

Y011all,..,11 a

10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER NURSES STATION

.-1,,-,WA., I ...I

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- 1,.1,1allA.Illl J

10/16/23 SO/SV 9 2nd BLD 9 FL2 CENTER CORRIDOR AREA

.-1,- ./ 1 V

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.-1,,Jallilll I 1-1

10/16/23 SO/SV 9 2nd BLD 9 FL2 EAST HALLWAY

4,..0.1,VVV UV

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Inspections Performed By Veterans Adminstation Fire Department (VAFD)

-Jr The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Strobes/ Speaker Strobes

10/16/23

10/16/23

ANNUAL

Strobes/ , '. •,.. ,. ^ v. , . t-- -., •., . , ..-. .--,., , . • ... ..._. ............., Speaker Strobes

Cust Zone No.

Comments Notes

Service Performed

Test

Date Tested Device Type Building Floor Location

- ,....1.,,Illt.1 I

10/16/23 SO/SV 9 2nd BLD 9 FL2 EAST ROOM 206

VOL/al./UV, 10/16/23 SO/SV 9 2nd BLD 9 FL2 EAST ROOM 207

.-1,JULA.IllULI, 10/16/23 SO/SV 9 2nd BLD 9 FL2 EAST ROOM 207

,01....GLIUXII.I,

10/16/23 SO/SV 9 2nd BLD 9 FL2 EAST STAIRWELL

9,-1,-llIlla

10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST STAIRWELL

YJVal/VVIJI., 10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST WING HALLWAY

.-1.,,aLllt-Illl! I

,,JW.L.A.PalllJtJ

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•-,),C.l.IlllIall

10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 321

.1,-Pa LLIAll I a , 10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 327

YOULLIVLIJG

, AJLIGLIlll/ JO

Y•ll. ..1a, 10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 326

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10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 328

.-..IllL.LIldllaiJ

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Vs..". J GUI., all

10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 329

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10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST ROOM 318

,,,ILLAJI.1 II-Pa

10/16/23 SO/SV 9 3rd BLD 9 FL3 WEST STAFF BATHROOM

Y.-1,1GL,, I I./ I

10/16/23 SO/SV 9 3rd BLD 9 FL3 CENTER WAITING AREA

.1.-Pal-.., 10/16/23 SO/SV 9 3rd BLD 9 FL3 ELEVATOR LOBBY

,..1 ,aall ,all I u, 10/16/23 SO/SV 9 3rd BLD 9 FL3 ELEVATOR LOBBY

..,../l/LI.A.,/

10/16/23 SO/SV 9 3rd BLD 9 FL3 CENTER HALLWAY

.-N-Ilial/VA! I A./../

10/16/23 SO/SV 9 3rd BLD 9 FL3 NORTH STAIRWELL

10/16/23 SO/SV 9 3rd BLD 9 FL3 CENTER ROOM 315

Y.-A V I 1./../

10/16/23 SO/SV 9 3rd BLD 9 FL3 NURSES STATION

4,IllalllIll I Ill

,,all.alll-A-1 I I I

,JULlliall I I a

10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST WING HALLWAY

YOULl./VW I I J

.-..ILIGlIkl ,l I I, 10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST ROOM 302

..-VVV I I ll

10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST ROOM 304

YOLILSILISI I I I

10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST ROOM 305

YOUL-Ul.11. I I I LI

10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST ROOM 306

.1,-IllalIlIV I I a

10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST ROOM 306

.-1,,,,,,, I l-l/

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Facility Name Building 9 Type Of Equipment Inspected Strobes/ Speaker Strobes

Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

ANNUAL

10/16/23 10/16/23

Inspections Performed By Veterans Adminstation Fire Department (VAFD)

VP The The Joint Commission

Date Tested Device Type t ro es pea er rob

Location es Cust

Zone No.

Building Floor Comments

Notes Service

Performed Test

Result 10/16/23 SO/SV 9 3rd BLD 9 FL3 EAST STAIRWELL

YOULLA-Ill I G I

10/16/23 SO/SV 9 Attic BLD 9 ATTIC NORTH STAIRWELL

.1,-,ILLAJLI I GC

10/16/23 SO/SV 9 Attic BLD 9 ATTIC

.,..Illll I GO

.-N.A.J.GVV ,./ I GY

,, .., I [ prir The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

"rainpers Switches 10/16/23 10/16/23

ANNUAL

EC .02.03.05 [P3

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Joint Commision Environment Of Care Detail Report- EC .02.03 05 EP 3

Date Tested

Device Type Building Floor

Tamp e rs wtches Cust

Zone No.

Comments

Notes Service

Performed Test

10/16/23 TS 9 1st Stairwell 1 43020153

Tested Passes 10/16/23 TS 9 1st South Stairwell #1 43020162

10/16/23 TS 9 1st North Stairwell #3 43020164

10/16/23 TS 9 1st Center stairwell#2 43020177

10/16/23 TS 9 1st Ply Stair #2 43020178

10/16/23 TS 9 1st South by AM 115C 43020179

10/16/23 TS 9 1st PIV By RM 115C 43020180

10/16/23 TS 9 1st North Stairwell #3 43020179

10/16/23 TS 9 2nd South Stairwell #1 43020166

10/16/23 TS 9 2nd North Stairwell #3 43020168

10/16/23 TS 9 3rd South Stairwell #1 43020170

10/16/23 TS 9 3rd North Stairwell #3 43020172

10/16/23 TS 9 Attic Center stairwell#2 43020174

Pr V The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Flow Switches 10/16/23 10/16/23

ANNUAL

NFPA Standards NFPA 72, 2021

Flow Switches

Date Tested Device Type Building Floor Location Cust

Zone No.

Comments

Notes Service

Performed Test

10/16/23 WF 9 1st South Stairwell #1 43020161

10/16/23 WF 9 1st North Stairwell #3 43020163

10/16/23 WF 9 2nd South Stairwell #1 43020165

10/16/23 WF 9 2nd North Stairwell #3 43020167

10/16/23 WF 9 3rd South Stairwell #1 43020169

10/16/23 WF 9 3rd North Stairwell #3 43020171

10/16/23 WF 9 Attic Center stairwell#2 43020173

NFPA Standards NFPA 72, 2021 Ref NFPA 72, 2010

Inspections Performed By Veterans Adminstation Fire Department (VAFD) prir The Joint Commission

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection

Hest Detectors

Heat Detectors Date Tested Device T .e Build' Floor Location

Cust Zone No.

Comments Notes

Service Performed

Test

10/16/23 RR 9 Attic Center Top of shaft 43020012

10/16/23 RR 9 Attic Center Top of Shaft 2 43020025

Enter Svc Notification

10/16/23

ANNUAL

Facility Name Building 9 Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection Total Devices In Inventory Total Devices Tested

Inspections Performed By Veterans Adminstation Fire Department (VAFD)

V The Joint Commission Monitoring CO

NFPA Standards Ref

EC .02.03.05 EP 5 Joint Commision Environment Of Care Detail Report-

Emer Svc Notificat Time

Tested Zone No. Date Tested Notes Device Type Floor Building Location

Time Notification

Received 45 Seconds

Service Preformed

Tested

Test Results

Passed 10/16/23 Dial 45 1st FACP N32L1S6 1332

VA Fire Department

EC .02.03.05 EP 5

Alex. VA Fire Department

NFPA 72, 2021

Type Of Equipment Inspected Date Inspections Began Date Inspections Ended

Frequency/Type of Inspection

V

Main Drain Tests

EC .02.03.05 EP 9

k Standards Ref

NFPA 72, 2021

Joint Commision Environment Of Care Detail Report- EC .02.03.05 EP 9 v 'a.-in iser or on ro Valve & Type

., _,.,, „...__,.,.. . . rain e , s s a Ic

Location Pressure esr a

Pressure eturn me to Statis Presure Performed Result

10/16/23 MD 9 Control North End (3rd Floor) 135 120 2 min 45 Sec Tested Passed 10/16/23 MD 9 Control South End (3rd Floor) 125 110 3min. 15 sec. Tested Passed 10/16/23 MD 9 Control North End 2nd Floo 125 110 2 min. 50 sec Tested Passed 10/16/23 MD 9 Control South End (2nd Floor) 135 125 3min 5 sec. Tested Passed 10/16/23 MD 9 Control North End 2nd Floo 130 120 2min. 45 sec. Tested Passed 10/16/23 MD 9 Control South End (2nd Floor) 140 130 2 min. 40 sec. Tested Passed 10/16/23 MD 9 Control Attic 150 140 3 min Tested Passed

Fire Dept Connections

10/16/23

ANNUAL

NFPA Standards TJC Ref NFPA 25, 2020

Ref NFPA 25 2009 Table 5.1

Facility Name Type Of Equipment Inspected Date Inspections Began Date Inspections Ended Frequency/Type of Inspection Total Devices In Inventory ir-

Building 9 Company Performing Inspections VA Fire Department

EOC/EP Ref. # EC .02.03.05 EP 10

EC .02.03.05 EP 10

Fire Dept Connections

FDC Is Visible Couplings-Swivels Are Not Damaged And

Plugs & Caps Are In Place And

Gaskets In Place And In ID Signs Check Valve

Auto Drain Valve In Place &

Operating Properly

Clappers In Place &

Operating Properly

Date Tested Device Type Accessible Rotate Smoothly Undamaged Location Good Condition In Place Not Leaking Performed Result 10/16/23 I.DC Yes Yes Yes Yes Yes Yes Yes Yes 10/16/23 tIC Yes Yes Yes

Yes Yes Yes Yes Yes 10/16/23 DC Yes Yes Yes

10/16/23 Yes Yes Yes