Semi-annual FM200 4-28-2025.pdf

Fire Suppression Inspection and Testing Report

Location Code: IZJKQQS

Contact: Owner or Manager

Contact Address: 975 KIRMAN AVE

RENO, NV 89502-0993

Phone: 775-384-3958

Email:

Property Evaluated: VA SIERRA NV HEALTH CARE

(Assembly)

975 KIRMAN AVE

RENO, NV 89502-0993

Description: Fire Suppression (Semiannual 2025)

Work Order: SV2504011140@@1

Company: Western States Fire Protection

Address: 1655 Marietta Way, Suite 105

Sparks, NV 89431-6000

Company Phone: 775-359-0396

Company Fax: 775-418-5171

Inspector: Adam B Blanco

Date of Work: 4/28/2025

Frequency: Annual

Tag: Normal

Deficiency Summary

There are no reported deficiencies for this submission

General Comments

These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection.

There are no general comments for this submission

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 1 of 9

Western States Fire Protection 1655 Marietta Way, Suite 105 Sparks, NV 89431-6000 Phone: 775-359-0396

Fire Suppression Inspection and Testing Report

Tag Normal Inspection Frequency: Annual Property Being Evaluated:

VA SIERRA NV HEALTH CARE (Assembly) Owner:

Terry Barton Owner's Phone Number:

775-384-3958 Property Address:

975 KIRMAN AVE, RENO, NV, 89502-0993

Assembly Description:

Fire Suppression (Semiannual 2025)

1. General A. (To be filled out by the Owner or Owner's Representative) Has the Owners section been answered on another inspection report that will be submitted with this inspection report? Yes No Owner not Available

2. Monitoring Information Is there a monitoring entity? Yes No

3. Notifications Made Prior To Testing

Contact Time

Monitoring organization: Control Room Prior to Arrival

Building management: Ricky 0800

4. System Information - Panels / Power

4.1 Addressable Panels

Control Unit Manufacturer:

Siemens

Model Number:

FHA2056

Location:

By main entry

Software Revision:

Unknown

SLC Loops Max #:

# Utilized:

Addresses Available:

Unknown

NAC

Circuits

Max #:

# Utilized:

Style/Class:

B, & Y

Primary Power Voltage:

Amps:

DNI

Overcurrent Protection Type:

Breaker

Amps:

Disconnecting Means Location:

Panel GELB Circuit 18

Battery 1 Voltage:

Amps:

Mfr Year:

Load Test Battery 1 VDC:

13.53 Ah:

Charger Voltage:

27.08

Result of Battery 1 & 2

Battery 2 Voltage:

Amps:

Mfr Year:

Load Test Battery 2 VDC:

13.54 Ah:

Charger Voltage:

27.08

Pass Fail Replaced

Secondary Power

Other Power Present?

Yes No Description:

4.3 Additional Power Supplies

Are there additional power supplies? Yes No

4.4 Suppression Cylinder Inspection

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 2 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

Suppression Cylinder Inspection Table

Area / Location In Fan Control Room

Manufacturer / Model Siemens

Cylinder Date 07/13

Primary or Reserve

Primary Reserve

Agent Type HFC-227ea

Firing Head or Initiator Solenoid

Initiator Date Code AA1335

Gauge Pressure 360 psi

Gross Weight 649 lbs

Agent Weight 305 lbs

Liquid Level Indicator 14”

Last Hydrotest Performed 07/13

Cylinder Serial Number

AA639343

Last Cylinder Service Date

07/13

Area / Location In Fan Control Room

Manufacturer / Model Siemens

Cylinder Date 10/14

Primary or Reserve

Primary Reserve

Agent Type HFC-227ea

Firing Head or Initiator Tandem

Initiator Date N/A

Gauge Pressure 360 psi

Gross Weight 204 lbs

Agent Weight 90 lbs

Liquid Level Indicator 9”

Last Hydrotest Performed 10/14

Cylinder Serial Number

AA717228

Last Cylinder Service Date

10/14

4.5 Additional Cylinder Info

What is the release type? Pneumatic Electric Other Select the Electric release type. IVO GCA Solenoid SQUIB What is the hazard reserve protection? Wet Sprinkler Dry Sprinkler PreAction

Clean Agent Gas Other None

5. Testing Results

5.1 Control Unit and Related Equipment

Description Visual Inspection Functional Test Results

Control unit Yes No Yes No Pass Fail N/A

Lamps / LEDs / LCDs Yes No Yes No Pass Fail N/A

Fuses Yes No Yes No Pass Fail N/A

Trouble signals Yes No Yes No Pass Fail N/A

Disconnect switches Yes No Yes No Pass Fail N/A

Ground-fault monitoring Yes No Yes No Pass Fail N/A

Supervision Yes No Yes No Pass Fail N/A

Annunciators Yes No Yes No Pass Fail N/A

Remote power panels Yes No Yes No Pass Fail N/A

Other Yes No Yes No Pass Fail N/A

5.2 Secondary Power

Description Visual Inspection Functional Test Results

Battery condition Yes No Yes No Pass Fail N/A

Load voltage Yes No Yes No Pass Fail N/A

Discharge test Yes No Yes No Pass Fail N/A

Charger test Yes No Yes No Pass Fail N/A

Remote panel batteries Yes No Yes No Pass Fail N/A

5.3 Alarm and Supervisory Alarm Initiating Device

Complete supplementary device test form for all initiating devices.

a. Did all tested initiating devices pass? Yes No N/A

5.4 Notification Appliances

Include Notification Appliances Table on this Report? Yes No

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 3 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

Notification Appliances

Appliance Type Notification Function # Installed # Tested Test Results

Bell(s) 0 0 Pass Fail N/A

Horn(s) 0 0 Pass Fail N/A

Horn/Strobe(s) Pre Discharge/Discharge 2 2 Pass Fail N/A

Mini Horn(s) 0 0 Pass Fail N/A

Speaker(s) 0 0 Pass Fail N/A

Speaker/Strobe(s) 0 0 Pass Fail N/A

Strobe(s) Pre Discharge/Discharge 2 2 Pass Fail N/A

5.5 Interface Equipment

Include Interface Equipment on this Report? Yes No Interface Equipment

Description Contact Aux Relay # Installed # Tested Test Results Comments

HVAC Open Closed Yes No 1 1 Pass Fail N/A

Dampers Open Closed Yes No 0 0 Pass Fail N/A

EPO (Emergency Power Off) Open Closed Yes No 1 1 Pass Fail

N/A

Bypassed prior to inspection. Did not inspect.

Door Control Open Closed Yes No 0 0 Pass Fail N/A

Building Alarm Tie in Open Closed Yes No 1 1 Pass Fail

N/A

5.6 Supervising Station Monitoring

Description Yes/No Time (sec) Results

Alarm signal Yes No Pass Fail N/A

Alarm restoration Yes No Pass Fail N/A

Trouble signal Yes No Pass Fail N/A

Trouble restoration Yes No Pass Fail N/A

Supervisory signal Yes No Pass Fail N/A

Supervisory restoration Yes No Pass Fail N/A

5.7 Air Sampling Detection

Is there Air Sampling Detection? Yes No

5.8 Device Information

Devices

Pull Station Manufacturer(s) Siemens

Type Keyed Hex Key Screw

Detector manufacturer(s) Siemens

Notification device manufacturer(s) Siemens

Color Red White

6. Notifications That Testing Is Complete

Contact Time

Monitoring organization: Control Room After Departure

Building management: Ricky 1000

7. System Restored To Normal Operation Date: 4/28/2025 Time: 1000

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 4 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

8. Observations These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection.

Please see the summary section at the top of the form for the comments.

9. Inspector Information:

Test Verification:

Inspected By Adam B Blanco Inspector Signature

Inspector License: 3506 Date of Work 4/28/2025 Inspection Notes

Room Integrity

a. Is integrity of the hazard space visually acceptable? Yes No N/A

b. Are door sweeps & door frame weather stripping installed? Yes No N/A

c. Are door stripping and sweeps free of any light penetrations? Yes No N/A

d. Are doors self-closing? Yes No N/A

e. Did doors closures operate properly? Yes No N/A

f. Are wall and ceiling penetrations properly sealed? Yes No N/A Safety Requirements: CO2 Systems

a. Signage: Is proper signage installed? Yes No N/A

b. Is a Pneumatic Delay Timer & Pneumatic Pre-Discharge Alarm installed? Yes No N/A

c. Are lock-out valves available? Yes No N/A

d. Is a Solenoid disconnect switch or releasing circuit disconnect available at the control panel? Yes No N/A

e. Are visual and audible devices located at the entrance to each occupiable space protected by a CO2 system & at the entrance to each space where CO2 could migrate? Yes No N/A

f. Are provisions available to prohibit entry of unprotected personnel to the protected spaces. If yes, what type? Yes No N/A

If Yes, what type? Distinctive Odorizer Automatic alarms activated by CO2 or O2 detect ors Establishment & enforcement of confined space entry procedures for such areas.

Safety Requirements: Clean Agent Systems

a. Signage: Is proper signage installed? Yes No N/A

b. Is a Solenoid Disconnect Switch or Releasing Circuit Disconnect available at the control panel? Yes No N/A

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 5 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

10. Suppression Deficiency

Legend

AED - Automated External Defibrillator

AF - Anti-Freeze AO - Audio Only APS - Air Pressure Switch

AS - Abort Station AV - Audio/Video

BATT - Batteries BP - Backflow Prevention

CM - Control Module COM - Communicator CON - Controller CoD - Carbon Monoxide Detector

Combo Detector - Combo Detector

DA - Damper DD - Duct Detector DH - Door Holder DSD - Door Smoke Detector

ED - Electrical Driver

EL - Emergency/Exit Light

ER - Elevator Recall FACP - Fire Alarm Control Panel

FDC - Fire Department Connection

FP - Fire Pump FP-D (NOFLOW) - Fire Pump Diesel No Flow

FP-E (NOFLOW) -

Fire Pump Electric No Flow

FPP - Fire Pump Power

FPR - Fire Pump Running

GAUGE - GAUGE H/S - Horn-Strobes HD - Heat Detector

HOOD - HOOD HORN - Horns INSPT - Inspector's Test

JC - Jockey Controller JP - Jockey Pump LA - Low Air

LS-HIGH - Level Switch High

LS-LOW - Level Switch Low

MM - Monitor Module (Ansul, temp, CO, etc)

MON - Monitoring MR - Manual Release Other - Other

PR - Phase Reversal PS - Pull Station PWS - Power Supply RDD - Roll Down Door

Relay Module - Relay Module

S/S - Speaker-Strobes

SBS - Sprinkler Box Spares

SC - Signal/Sounder Control

SD - Smoke Detector SD-Ion - Ion Smoke Detector

SD-Photo - Photo Smoke Detector

SPKLR HEADS -

SPKLR HEADS

SPKR - Speakers STANDPIPE -

STANDPIPE

STROBE - Strobes TEMP - Temperature Switch

TS - Tamper Switch VO - Visual Only

WF - Waterflow

Asset Type Total Teste d

Not Teste d

Passe d

Failed Asset Type Total Teste d

Not Teste d

Passe d

Failed

AS 2 2 0 2 0 PS 2 2 0 2 0

SD 22 21 1 21 0

Zone: Center Server

Zone: Center Server

Asset Type

Address Location Notes Frequenc y

Last Tested

Test Results

Comments

SD Ceiling East Annual 4/28/2025 Pass

SD Ceiling West Annual 4/28/2025 Pass

SD Inside Server East Annual 4/28/2025 Pass

SD Inside Server West Annual 4/28/2025 Pass

SD Subfloor East Annual 4/28/2025 Pass

SD Subfloor West Annual 4/28/2025 Pass

Zone: Fan Control Room

Zone: Fan Control Room

Asset Type

Address Location Notes Frequenc y

Last Tested

Test Results

Comments

SD Ceiling North Annual 4/28/2025 Pass

SD Ceiling South Annual 4/28/2025 Pass

SD Subfloor North Annual 4/28/2025 Pass

SD Subfloor South Annual 4/28/2025 Pass

Zone: North Server

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 6 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

Zone: North Server

Asset Type

Address Location Notes Frequenc y

Last Tested

Test Results

Comments

SD Ceiling East Annual 4/28/2025 Pass

SD Ceiling West Annual 4/28/2025 Pass

SD Inside Server East Annual 4/28/2025 Pass

SD Inside Server West Annual 4/28/2025 Pass

SD Subfloor East Annual 4/28/2025 Pass

SD Subfloor West Annual 4/28/2025 Pass

Zone: Server Room

Zone: Server Room

Asset Type

Address Location Notes Frequenc y

Last Tested

Test Results

Comments

AS North Entry Annual 4/28/2025 Pass

PS North Entry Annual 4/28/2025 Pass

AS South Entry Annual 4/28/2025 Pass

PS South Entry Annual 4/28/2025 Pass

Zone: South Server

Zone: South Server

Asset Type

Address Location Notes Frequenc y

Last Tested

Test Results

Comments

SD Ceiling East Annual 4/28/2025 Pass

SD Ceiling West Annual 4/28/2025 Pass

SD Inside Server East Annual 4/28/2025 Pass

SD Inside Server West Annual 4/28/2025 Pass

SD Subfloor East Annual 4/28/2025 Pass

SD Subfloor West Cannot access, under equipment. N/A

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 7 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

Panel returned to normal operations at time of departure.

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 8 of 9

Sparks, NV 89431-6000 Phone: 775-359-0396

Tanks returned to normal operation at time of departure.

Western States Fire Protection, 1655 Marietta Way, Suite 105, Sparks, NV, 89431-6000 Phone: 775-359-0396 Page 9 of 9