Atch 006 - Inpsection Deficiency Reports.pdf

WHITE-CUSTOMER YELLOW-TECHNICIAN PINK-HOME OFFICE FA Insp Report Page 1 of 1

Contract Number

BATTERY VOLTAGE TYPE:

VDC VDC AH

VDC VDC AH

DART

BATTERY VOLTAGE TYPE:

VDC VDC AH

VDC VDC AH

RESISTORS IN PROPER LOCATION LED TEST SWAPPED BATTERIES

NOTE: NOTE:

DD H PS DH CP

SD S WF KS AN

HD B TS SUP PIV

SPK C RM CM MM

ANNUNCIATOR

SERIAL NUMBER LOCATION

FIRE ALARM

Fort Campbell, Kentucky

2x12v 7AHBATTERY CHARGING VOLTAGE

MODEL

RESPONSE TO ALARM MANUFACTURER

BATTERY CHARGING VOLTAGE

SPECIAL CONSIDERATIONS - List any unique functions to be aware of before testing

NOTES, FAILURES AND SYSTEM DEVIATIONS FROM NFPA STANDARDS

PANEL MANUFACTURER MODEL

LOCATION

CIRCUIT BREAKER LOCATION

X Fire Alarm License #:

RESPONSE TO TROUBLE

SERIAL NUMBER

CITY, STATE, ZIP

INSPECTION REPORT

RM

LAMPS / LED TEST

MODEL

INSPECTION DATES: INSPECTION TEAM:

PANEL MANUFACTURER

Fort Campbell 911 Fire Department

LOCATION

TECH SIGNATURE

PRINT NAME: PHONE

Fort Campbell Army Base

BUILDING #

Fort Campbell, Kentucky

ADDRESS

JOBSITE NAME

BUILDING CONTACT

MONITORING AGENCY AUTHORITY HAVING JURISDICTION

CONTROL PANEL

-Pull Station -Water Flow -Tamper Switch

-Relay Module

-Duct Detector -Smoke Detector -Heat Detector

-Horn

-Bell -Strobe

-Speaker

-Control Panel -Annunciator -Post Indicator Valve

-Monitor Module

-Door Holder -Key Switch -Supervisory

-Control Module-Chime

Quarterly

Bi-Annual

Other

Annual

PASS FAIL

PASS FAIL

PASS

PASS

FAIL

FAIL

PASS FAIL NOTE:

CI TY CON N ECTI ON CEN TRA L M ON I TORI N G STA TI ON N/A

NORM N/A NOTE:

NORM N/A NOTE:

PASS FAIL

PASS FAIL

PASS FAIL

PASS

PASS

FAIL

FAIL

YES NOPASS FAIL

NONE AS FOLLOWS (DESCRIBE FULLY)

YES NO

X

BATTERY VOLTAGE TYPE: 2 X 12V-7.0

VDC VDC AH

VDC VDC AH

DISABLE RELEASE PROCEDURE

INSPECTION DATES: INSPECTION TEAM:

INSPECTION REPORT

FIRE ALARM PANEL 2

Fort Campbell, Kentucky

TECH SIGNATURE X Fire Alarm License #:

JOBSITE NAME Fort Campbell Army Base

ADDRESS

CUSTOMER CONTACT

AGENT RELEASE PANEL

CITY, STATE, ZIP Fort Campbell, Kentucky

PRINT NAME: SIGNATURE

AGENT RELEASE PANEL MODEL LOCATION

MONITORING PANEL AUTHORITY HAVING JURISDICTION

FCI Fire Department

BATTERY CHARGING VOLTAGE

CIRCUIT BREAKER LOCATION LAMPS / LED TEST

ANSUL AUTOPULSE 4000

ANNUNCIATOR

RESPONSE TO ALARM MANUFACTURER MODEL LOCATION

RESPONSE TO TROUBLE

FAILURES AND SYSTEM DEVIATIONS FROM NFPA STANDARDS

Jobsite:

DEVICE ALM

P / F

TRB

P / F

C L E A N E D

V I S

I N

S SE

N

SI

TI

V

IT

Y

N O

TE

S:

(R ef

SA

3RD FLOOR

PS HALL BY ROOM 343

SD HALL BY ROOM 346 AREA C

SD HALL BY ROOM 350

SD HALL BY ROOM 352

SD HALL BY ROOM 354

PS STAIR EXIT BY 354

SD HALL BY ROOM 360

HD COMM CLOSET ROOM 358

SD HALL BY ROOM 364

SD HALL BY ROOM 366 AREA D

SD HALL BY ROOM 370

HD COMM ROOM 371

SD CORRIDOR BY 372

PS STAIR EXIT BY 375

SD HALL BY ROOM 376

SD HALL BY ROOM 380

PS STAIR EXIT BY ROOM 380

2ND FLOOR

PS STAIR BY ROOM 280

SD HALL BY ROOM 280

SD HALL BY 276

SD HALL BY ROOM 272

PS STAIR EXIT BY 275

HD COMM ROOM 271

SD HALL BY ROOM 270

SD HALL BY ROOM 266

SD HALL BY ROOM 264

SD HALL BY ROOM 260

HS HALL BY ROOM 260

HD COMM CLOSET ROOM 257

SD HALL BY ROOM 258

PS STAIR EXIT BY 254

SD HALL BY ROOM 252

DEVICE LOCATION / ADDRESS

Fort Campbell Army Base - Building 6764

Fort Campbell, Kentucky

FIRE PROTECTION DEVICES

INSPECTION REPORT

WHITE-CUSTOMER YELLOW-TECHNICIAN PINK-HOME OFFICE FA Device Failure Report Page 1 of 1

X

DD H PS DH CP

SD S WF KS AN

HD -Heat Detector B -Bell TS -Tamper Switch SUP -Supervisory PIV -Post Indicator Valve

SPK -Speaker C -Chime RM -Relay Module CM -Control Module MM -Monitor Module

INSPECTION REPORT

FIRE ALARM FAILURE

-Duct Detector -Door Holder -Key Switch -Annunciator

Fort Campbell, Kentucky

-Smoke Detector -Strobe -Water Flow

CUSTOMER CONTACT

Fully describe failures and/or recommendations:

-Pull Station -Control Panel-Horn

TECH SIGNATURE

ADDRESS

INSPECTION DATES:

PRINT NAME:

Fort Campbell, KentuckyCITY, STATE, ZIP

INSPECTION TEAM:

X Fire Alarm License #:

SIGNATURE

BUILDING NUMBER

Quarterly

Annual

Bi-Annual

WHITE-CUSTOMER YELLOW-TECHNICIAN PINK-HOME OFFICE AUX EQUIP FA Aux Equip Report Page 1 of 1

Fort Campbell, Kentucky

AUXILIARY EQUIPMENT

INSPECTION REPORT

Contract Number

TYPE:

VDC VDC AH

VDC VDC AH

TYPE:

VDC VDC AH

VDC VDC AH

VDC VDC AH

VDC VDC AH

VDC VDC AH

VDC VDC AH

SIGNALS SOUNDED AT CUSTOMER REQUEST

LAMPS / LED TEST

LOCATION

SIGNALING

AH TEST 12v 7 AH

LOCATION

NOTES, FAILURES AND SYSTEM DEVIATIONS FROM NFPA STANDARDS

LOCATION

BATTERY CHARGING VOLTAGE BATTERY VOLTAGE

FUNCTIONS

HOLDERS

POWER EXPANDER/AUDIO-VISUAL PANEL

INSPECTION PERIOD

CIRCUIT BREAKER LOCATION

X Fire Alarm License #:

BATTERY CHARGING VOLTAGE BATTERY VOLTAGE

INSPECTION DATES: INSPECTION TEAM:

BUILDING NUMBER

TECH SIGNATURE

SERIAL NUMBERMODEL

SIGNALING SIGNALS SOUNDED AT CUSTOMER REQUEST

PANEL MANUFACTURER

DOOR

ANNUNCIATOR

MANUFACTURER MODEL SERIAL

AUXILIARY

ADDITIONAL ANNUNCIATOR

TYPE / IDENTIFICATIONAH TEST

SERIAL NUMBER

CIRCUIT BREAKER LOCATION LAMPS / LED TEST

BATTERY CHARGING VOLTAGE BATTERY VOLTAGE

ADDITIONAL BATTERIES

AH TEST

POWER EXPANDER/AUDIO-VISUAL PANEL

PANEL MANUFACTURER MODEL

Monthl Quarterl Semi- Annua Othe

PAS FAIL PAS FAIL

PAS FAIL NOTE

CODE PRE- NOT YE NOGENERAL SELECTIVE

PAS FAIL NOTE

CODE PRE- NOT YE NOGENERAL SELECTIVE

PAS FAIL PAS FAIL

PAS FAIL PAS FAIL

PAS FAIL PAS FAIL PAS FAIL

PAS FAIL PAS FAIL PAS FAIL

PAS FAIL PAS FAIL

NOR N/A NOTE

LAMP

DRILL

REMOTE

REMOTE

NON AS FOLLOWS (DESCRIBE

PAS FAIL PAS FAIL

PAS FAIL PAS FAIL PAS FAIL

FCI

BATTERY VOLTAGE TYPE: 2 X 12V-12AH

VDC VDC AH

VDC VDC AH

DISABLE RELEASE PROCEDURE

FAILURES AND SYSTEM DEVIATIONS FROM NFPA STANDARDS

RESPONSE TO TROUBLE

ANNUNCIATOR

RESPONSE TO ALARM MANUFACTURER MODEL LOCATION

BATTERY CHARGING VOLTAGE

CIRCUIT BREAKER LOCATION LAMPS / LED TEST

Fire Department

AGENT RELEASE PANEL MODEL LOCATION

CUSTOMER CONTACT

AFFF RELEASE PANEL

FACP MONITORING LOCATION AND TYPE AUTHORITY HAVING JURISDICTION

ADDRESS

CITY, STATE, ZIP Fort Campbell, Kentucky

PRINT NAME: SIGNATURE

TECH SIGNATURE X Fire Alarm License #:

JOBSITE NAME Fort Campbell Army Base - Building 6627

INSPECTION DATES: INSPECTION TEAM:

INSPECTION REPORT

AFFF RELEASE PANEL

Fort Campbell, Kentucky

INSPECTION TEAM:

X

N/A YES NO

b. Foam supply and quality at adequate level..

c. Actuators in proper position?

2. ANNUAL INSPECTION:

Control valves "OS&Y" supervised in open position.

3. BI-ANNUAL INSPECTION:

a. OS&Y lubricated.

b. OS&Y operated through entire travel.

c. OS&Y packing in good condition.

d. all piping, hangers, heads, and nozzles in proper

AFFF

Fort Campbell, Kentucky

INSPECTION DATES:

TECH SIGNATURE

JOBSITE NAME Fort Campbell Army Base

INSPECTION REPORT

1.SEMI-ANNUAL INSPECTION:

DISABLE all release modules before testing.

BUILDING NUMBER

CITY, STATE, ZIP Fort Campbell, Kentucky

a. Are any systems out of service?

test level % of concentrate put test information in notes

e. All strainers internally inspected and cleaned.

SPECIAL CONSIDERATIONS - List any unique functions to be aware of prior to testing condition and location.

INSPECTION TEAM:

X

N/A YES NO

b. All piping in good condition.

c. All nozzles in good condition and properly located.

d. All flexible hoses free from damage.

e. Exterior of tanks or cylinders free from damage.

f. Agent at sufficient level.

g. Agent/propellant pressure at adequate level.

h. All manual actuators in accessible location.

i. All required devices release agent.

m. Pre-alarm works properly

n. Abort switches accessible and work properly.

o. More than one detector required to release agent.

Fort Campbell. Kentucky

FIRE ALARM

INSPECTION REPORT

INSPECTION DATES:

07/25/06

TECH SIGNATURE

JOBSITE NAME

1. ANNUAL INSPECTION: SYSTEM 1

DISABLED all agent release modules before testing.

Fort Campbell Army Base 6551 Building number

CITY, STATE, ZIP Fort Campbell, Kentucky

SEE AGENT REPORT

a. Are any systems out of service?

Shunt trip, shut downs, dampers, and door holders.

k. Valves in proper alignment.

j. All auxiliary equipment work properly. Such as

a. Completely inspected exterior of cylinders to ensure suitable for use.

l. Affected areas able to contain agent if released.

2. FIVE-YEAR INSPECTION

SPECIAL CONSIDERATIONS - List any unique functions to be aware of prior to testing

THIS SYSTEM CONTAINS 4 TANKS. TANKS 1,2,3 & 4

b. Pressure testing hoses verified they are suitable for use.

DD H PS DH CP

SD S WF KS AN

HD B TS SUP PIV

SPK C RM CM MM

AGENT

Fort Campbell, Kentucky

TECH SIGNATURE X Fire Alarm License #:

INSPECTION DATES: INSPECTION TEAM:

INSPECTION REPORT

CITY, STATE, ZIP Fort Campbell, Kentucky

PRINT NAME: SIGNATURE

JOBSITE NAME Fort Campbell Army Base - 6551

ADDRESS

MEASUREMENTS OF TANKS

TANKS 1,2,3,4,5 and 6 48"X16" this is a 340 LB tank with a volume of 137.7 liters TANK 7 43"X12" this is a 186 lb tank with a volume of 75.4 liters TANK 8- 29"X8" this is a 54lb tank with a volume of 22.6 liters

CUSTOMER CONTACT

Fully describe failures and/or recommendations:

TANK 1 370 PSI

TANK 2 370 PSI

TANK 3 360 PSI

HALON LEVELS FROM THE BOTTOM OF TANK

TANK 1-29" TANK 2-27.25" TANK 3-27" TANK 4-28.5"

TANK 5-27.75" TANK 6-28" TANK 7-24.5" TANK 8-12"

TANK 8 355 PSI

ACTUAL HALON AMOUNTS:

Tank 1 = 282 Lbs Tank 2 = 265 Lbs

TANK 4 360 PSI

TANK 5 355 PSI

TANK 6 355 PSI

TANK 7 360 PSI

-Door Holder -Control Panel

Tank 3 = 262.5 Lbs Tank 4 = 277 Lbs Tank 5 = 270 Lbs Tank 7 = 147 Lbs

-Post Indicator Valve -Smoke Detector -Strobe -Water Flow -Key Switch

Tank 8 = 33 Lbs Total halo in building = 1536.5 Lbs

-Duct Detector -Horn -Pull Station

-Monitor Module-Speaker -Chime -Relay Module -Control Module

-Annunciator -Heat Detector -Bell -Tamper Switch -Supervisory

WHITE-CUSTOMER YELLOW-TECHNICIAN PINK-HOME OFFICE Sprinkler test report Page 1 of 2

INSPECTION REPORT

Contract Number

INSPECTION TEAM:

X yes no N/A yes no N/A

SPRINKLER SYSTEM

Fort Campbell, Kentucky

VALVE LOCATION VALVE SIZE AND TYPE

d. Are heads within age limit?

the correct sprinkler heads?

1.All Inspections: 4. Wet Systems Annual and Bi-Annual:

MAKE MODEL NUMBER

b. Are all valves and trim in good condition?

a. Does water flow devices work properly?

e. does system have a back flow at system?

f. Adequate heating, and on if necessary.

a. Is air compressor in service and in

SPECIAL CONSIDERATIONS - List any unique functions to be aware of prior to testing

e. Are fire department caps in good condition?

f. Alarm test in proper position.

d. Internally inspected valve for proper condition.

Pilot: Air:

3. Bi-Annual Inspections:

b. Operated valve to verify proper function?

Street: System:

Static: Residual:

6. Pre-action Bi-Annual

b. Is air pressure on the system satisfactory?

satisfactory operating condition?

c. Does low air supply works properly?

BUILDING NUMBER

b. Are PIV and OS&Y supervised. Lock or TS?

the sprinkler control valve and filled with

c. Is the sprinkler head cabinet mounted close to

a. Is System in operation?

INSPECTION DATES:

TECH SIGNATURE

CITY, STATE, ZIP Fort Campbell, Kentucky

ADDRESS

g. Gauges in good condition, 2.Annual and Bi-Annual Inspections:

indicate street, system, air, and pilot pressures.

Anti-freeze loops have correct solution mixture.

d. Does quick opening devices work properly?

e. All low points drained?

5. Dry Pipe Bi-Annual

d. Is fire department connection accessible?

c. Verify water supply "conduct main drain test"

e. All strainers cleaned and in proper condition.

e. All low points drained?

NOTES, FAILURES AND SYSTEM DEVIATIONS FROM NFPA STANDARDS

c. Verified water travels through inspectors test.

a. Are OS&Y stems lubricated?

Pressure readings:

a. Did system trip by device to verify operation?

d. Does quick opening devices work properly?

b. Did system trip by manual actuator?

c. Does low air supply works properly?

Wet

Pre-

Dry pipe

NON AS FOLLOWS (DESCRIBE

Quarterl

Bi-

Annua

Othe Othe

LBS. SUPPLY IN. GAP IN.

(IN./FT.)

PASSED FAILED PASSED FAILED

OPENED AT *PSID (2 PSID or more) OPENED AT PSID (2 PSID or more) direction of flow *PSID (5 PSID or more) direction of flow PSID (5 PSID or more)

(1st check - relief) PSID (3 PSID or more) (1st check - relief) PSID (3 PSID or more)

PASSED FAILED PASSED FAILED

direction of flow PSID (1 PSID or more) direction of flow PSID (1 PSID or more) direction of flow PSID (1 PSID or more) direction of flow PSID (1 PSID or more)

COMMENTS

CERTIFICATION NUMBER AND EXPIRATION DATE OWNER OR OWNER'S REPRESENTATIVE DATE

INSPECTION REPORT

TESTED BY (PRINT) (SIGNATURE) REPAIRED BY (PRINT)

COMPANY FINAL TEST BY (PRINT) (SIGNATURE)

Fort Campbell, Kentucky

BACKFLOW DEVICE

THE ABOVE REPORT IS CERTIFIED TO BE TRUE, ACCURATE, AND COMPLETE.

APPLICATION:

(SIGNATURE)

REPAIR HISTORY

2ND CHECK held in 2ND CHECK held in

NOTE: Failure or any of the above items, requires repair.

DOUBLE CHECK VALVE ASSEMBLY: DOUBLE CHECK VALVE ASSEMBLY:

1ST CHECK held in 1ST CHECK held in

NOTE: Failure or any of the above items, requires repair. *Pounds per Square Inch Differential

INITIAL TEST FINAL TEST AFTER REPAIR

NO. 2 SHUTOFF VALVE leak tight NO. 2 SHUTOFF VALVE leak tight 1ST CHECK held in 1ST CHECK held in

DIFFERENCE DIFFERENCE

RELIEF VALVE RELIEF VALVE

2ND CHECK held backpressure 2ND CHECK held backpressure

INITIAL TEST FINAL TEST AFTER REPAIR

REDUCED PRESSURE PRINCIPAL ASSEMBLY: REDUCED PRESSURE PRINCIPAL ASSEMBLY:

HEIGHT OFF FLOOR PROTECTION FROM: COMMENTS: NEW INSTALLATION?

FREEZING FLOODING

SERIAL NUMBERTYPE OF ASSEMBLY MANUFACTURER MODEL SIZE

METER NUMBER

DATE OF TEST TIME SUPPLY PRESSURE AIR GAP (2 X SUPPLY DIAM.)

CUSTOMER CUSTOMER NUMBER BUILDING NUMBER

FT, CAMPBELL KY

MAILING ADDRESS

SERVICE LOCATION

Bldg No Description of Deficiency MH Lab @ $0.00

Cost Est Mat Cost Total Est. Cost NOTES

1234 A Panel is shorted 10.00 Replace Panel

Sample deficiency