Attachment A - Fire Alarm Inspection Testing form.pdf

For “Name of Company” control only Building # Master FA Report 2021

“Company Name”

FIRE ALARM SYSTEMS

ITM REPORT/SPRINKLER

JBLM, WASHINGTON

Building Name: Monitoring Contact:

Building #: Joint Base Emerg. Control Center (JBECC)

Inspection Date: Time: 0700 Telephone: 253-912-4442

Company Information: Approving Agency:

Name: JBLM Lewis Public Works; Joe Jones

Address: C/0 Services Management Branch

Telephone: Telephone: 253-966-XXXX

Contract #:

Fire Prevention Officer: Individuals Name Testing Letter Given To: _________________ Date:

*Inform person-receiving letter, it is to be delivered to Fire Alarm Building Manager.

Transmitter Information: Transmitter Zone Information:

Zone Time

Z‐1:

Z‐2:

Z‐3:

Z‐4:

Z‐5:

Z‐6:

Z‐7:

Notes:Sensitivities done with UL217 smoke

#: Manufacturer: Monaco

Type of Transmission: RF

Type of Service: Annual

Location:

FACP Information:

FACP Manufacturer: Model #:

Circuit Class: Initiating: Indicating:

# of Circuits: Initiating: Indicating:

Software Rev.:

Last date service performed: First time new FACP system/building tested on this contract.

POC: _____________ POC#:____________________

Alarm Initiating Devices Information

Quantity Manufacturer Part # Device Types

Pull Stations Sync Module Smoke Detectors Duct Detectors Monitor Modules

PRIOR TO ANY TESTING

Notifications Are Made: Yes No Person Contacted Time

JBECC Monitor JBLM Public Works QC Joe Manfred 0700 Building Manager; CQ/OIC/NCOIC 0700 AHJ/DPW (Notified) of any impairments N/A

FACP System Power Supplies

a. Primary (Main): Nominal Voltage: 120V ac Amps: 20

Over Current Protection: Type: Circuit Breaker Amps: 20

Location (Panel Number):

Disconnecting Means Location: Circuit breaker #

Breaker Lock Installed? Yes No Secured inside mechanical room controlled by Public Works keys, no lock requested per Fire Department.

b. Secondary (Standby): 72 hours and 15 minutes in alarm OR 48 hours and 5 minutes in alarm Battery Calculation Unavailable: Cannot determine system operation design hours

c. Surge Suppressor for line Voltage:

Manufacturer: Transtector Model #: ACP100BWN3 Red indicator light on: Yes No Condition good: Yes No

FACP Batteries

Battery Type: Sealed Lead Acid Left Right Pass Fail

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

Charge Voltage:

Install date: Manufacturer date:

Transmitter Batteries

Battery Size: 2ea 12v AH AH Standby Voltage:

BPS #1 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

BPS #2 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

BPS #3 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

BPS #4 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

BPS #5 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

BPS #6 Batteries: Locaction AC Pwr Bkr:

Battery Size: 2ea 12v AH AH Load Voltage After 5 minute alarm:

Standby Voltage:

Charge Voltage:

Sprinkler Solenoid Information

Riser ID Location Disconnected

System Test and Inspections

Visual Functional Comments

Control Panel OK Interface Equipment OK Lamps/LEDS OK Fuses OK Primary Power Supply OK Trouble Signals OK Disconnect Switches OK Ground Fault Monitoring OK

Alarm Notification Appliances Information Device types Quantity Manufacturer Part # Pass Fail Horn/Strobe Triple Units Speaker Ceiling Ext WP Strb/SPK Ext WP Bell

Initiating and Supervisory Device Test and Inspection

Testing Method(s) Used: Functional

Location ID# Device Type

Visual Check

Functional Check

Factory Setting

Measured Setting

Pass Fail

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Location ID# Device Type

Visual Check

Functional Check

Factory Setting

Measured Setting

Pass Fail

N/A N/A

N/A N/A N/A N/A N/A N/A

Duct Detector was cleaned by Tech: ________________________________ Date: ________________

Sprinkler Solenoid Information

Riser ID Location Reconnected

Mass Notification Test

1. During Activation of all MN messages from ACU / LOC: YES NO

A. Fire/PA (when applicable) audible silenced

B. Amber (MN) strobes flash during MN message

C. White (fire) strobes turn off

D. Supervisory alarm sent to JBECC

Findings: N/A

2. ACU Tests: YES NO

A. Pre-approved messages programmed, labeled and activated:

B. Verify no feedback using microphone for local live voice:

C. Common troubles at ACU unit puts FACP into trouble.

Findings: ___________________________________

3. LOC (Remote panel/s) Test(s):

LOC #1 YES NO

A. Verify all messages can be activated and match chosen message

B. Message nameplate on panel(s)

C. Verify no feedback using microphone for live voice messaging:

Findings: ____________________________________

4. JBECC MNS Operations: YES NO

A. Can activate all messages

B. Verify live voice can be received at building

Findings: __________________________________

FACP and Transmitter Status On Completion of Testing

FACP is normal yes no Transmitter is normal yes no Status if not normal:_______________________________________________________ Tech__________________________________________________Date______________

Notification That Testing is Complete

Yes No Person Contacted Time JBECC Monitor

Building Manager; CQ/OIC/NCOIC 1530 JBLM Public Works (QC) Joe Manfred 1530

AHJ/DPW (Notified) of any impairments N/A

Changes to System Since Last Testing

Changes to system since last test: NO YES Comments:

Facility has general heat and smoke devices not required in common spaces. These devices are not ITM’d and should be removed. NO YES

Device at FACP: NO YES and devices at BPSs: NO YES N/A

System Components Operation

The following Component(s) not operational, (due to damage/removal or age of component):

1.)

2.)

Correction(s) made:

Date Corrected:

Inspected/Corrected by:

Number of Employees Testing:

Date System Restored to Normal Operation: Time: 1530

Sequence of Operation

1. All initiating devices report to Fire Alarm Panel and active warning devices.

2. Fire Alarm Panel reports to Radio Transmitter.

3. Radio Transmitter sends signal to base JBECC Dispatch Center.

4. Mass Notification System for use to broadcast emergency messages. (only use when MNS applies)

This Testing Was Performed In Accordance With Applicable NFPA Standards.

Name of Company Representative: George Mark Date:

Signature:

Name QC Representative: Joe Manfred Date:

Signature:

Name of JBLM Fire Department Representative:

Date:

Signature: