Semi-annual FM200 10-22-2024.pdf
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- Solicitation number
- 36C26126Q0018
About this file
This is a Suppression Inspection Report from Delta Fire Systems, Inc. for a fire suppression system inspection at the VA Hospital located at 975 Kirman Ave. in Reno, Nevada. The inspection was conducted on 10/22/24 at 08:00 by inspector Adam Blanco (License NV C of R 3506), covering a Halon-type fire suppression system with 1 SLC and 22 points. Key findings include: the system has two fire suppression containers (PSI 370 and 90), 2 manual release devices, 2 abort devices, and 22 smoke detectors. All system components were marked as passing inspection, with one notable recommendation to replace two 12v18ahF2 batteries due to expiration. The system was verified as clear of alarms and troubles, with building occupants and CMS (facility management) notified prior to the inspection.
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Yes No Who Time PSI Wght Initiator
CMS:
Occupnts Mngmnt
Horns Strobes Notes:
Bell
Type Qnty Style Pass Fail Yes No N/A MR
Abort Detection
Other Notes:
Explain: Yes No N/A
Yes No N/A Make: Condition Yes No N/A Model: Type: Yes No N/A A/C LED: Rly Discon Yes No N/A Troubles: NAC Trbl Yes No N/A Battery Time Dly Yes No N/A Detector Abort Yes No N/A MP Grnd Flt Yes No N/A Firing Ckt A/C Shunt Yes No N/A Press Sw. IRI Cut Notes:
Mod. Trbl Resistor Al LED Batt.'s vdc ah Notes:
Page-1
Date / Time:
Inspectors Name:
License # :
Initiator Ckt.:
Dents/Defects:
Mount. Brackets:
Pipes & Fittings:
Nozzels Secure:
Hoses:
Pressure Gauge:
Fan Test Performed
8) Agent Storage Containers & Piping Condition:
6) Initiating Devices
Pressure Switch:
Suppression Inspection Report W/ O #___________ PO#______________ Customer:
Contact:
Warranty Contract / P.O.
Inspection Date:
Inspection Time:
4) Systems Operations
Doors Sealed?
Sub-Fl. Openings?
{V = Visual Inspection} {P = Pass} {F = Fail} {N/A = Not Applicable}
Address & PH:
Type of System: FM200: P/A: CO2:
Container #
5) Containers1) Notifications Are Made
2) Notification Appliances
7) Room Integrity
Sub-Fl. Clean?
Ceil. Openings?
FACP Tie-In?
3) Area of Inspection Number of Zones/Points:_______________________
Control Unit:
Area Altered ?
Affect Syst. Integrity
HALON
5I1868
VA Hospital Terry Barton / Vadim
975 Kirman Ave. Reno, Nv 89502
N/A
12 18
Novac
1 SLC / 22 Points
Siemens
FC2025
P N/A P P P P P P
P DNI
P P P
13.57v 17ah 13.48v 17ah
370 305 Solenoid 370 90 Tandem
Tank 1 L.L. 14” Tank 2 L.L. 9”
2 Dbl. Act.
2 Push
22 Smoke
10/22/24 Adam Blanco NV C of R 3506
10/22/24 08:00
As Needed Ricky
P P P
AA639343
AA717228
10:00
Other
1)______ 6)______ 11)_____ 16)_____ 21)_____ 26)_____ 31)_____ 36)_____ 41)_____ 46)_____ 51)_____ 2)______ 7)______ 12)_____ 17)_____ 22)_____ 27)_____ 32)_____ 37)_____ 42)_____ 47)_____ 52)_____ 3)______ 8)______ 13)_____ 18)_____ 23)_____ 28)_____ 33)_____ 38)_____ 43)_____ 48)_____ 53)_____ 4)______ 9)______ 14)_____ 19)_____ 24)_____ 29)_____ 34)_____ 39)_____ 44)_____ 49)_____ 54)_____ 5)______ 10)_____ 15)_____ 20)_____ 25)_____ 30)_____ 35)_____ 40)_____ 45)_____ 50)_____ 55)_____ Notes:
Customer Signature:
X:
Page-2
Inspectors Signature:
X:
Customer Acceptance:
First: Last: Title:
Inspectors Remarks / Notes:
Inspectors Name:
First: Last:
Building Occupants Notified:
CMS Contacted:
Date & Time of Departure:
11) Items Should be Replaced Due to Age or Malfunction Quantity: Part Number: Model Number: Part Description:
N/A
YES
YES
Date:
N/A N/A N/A N/A N/A
NO
NO
NO
NO
NO
NO
Time:
Clear of Alarms & Troubles: YES
YES
YES
YES
Remote Alarms Reconnected:
Aux. Relays Connected:
Initiator/Solinoid Reconntd:
10) System Reactivation Check List: YES NO N/A Misc. Note(s)
9) Initiating Devices Type of System: HALON: FM200: P/A: CO2:
{V = Visual Inspection} {P = Pass} {F = Fail} {N/A = Not Applicable}
Suppression Inspection Report W/ O #___________ PO#______________ Warranty Customer:
Contract / P.O. Contact:
Inspection Date: Address & PH:
Inspection Time:
5I1868
VA Hospital Terry Barton / Vadim
975 Kirman Ave. Reno, Nv 89502
Novac
P P P P P P P P P P P P P P P P P P P P P P P P P P
10/22/24 10:00
12v18ahF2 batteries
Adam Blanco
Ricky Robinson Maintenance Tech.
Batteries have expired and need to be replaced.
Testing and Inspection tested to NFPA 2001 standards.
10/22/24 08:00
Sheet1
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