Attachment B - Kitchen Hood Suppression Form.pdf

Joint Base Lewis-McChord

RANGE HOOD SYSTEM

Acceptance and Semi-Annual Certification

Facility Name: DATE:

Building Number: Address:

Procedure Upon completion of the work, inspection and tests shall be made by the contractor’s representative and witnessed by an owner’s representative. All defects shall be corrected and system left in service before contractor’s personnel finally leave the job.

A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood the owner’s representative’s signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority’s requirements or local ordinances.

General Information

System Number of

System Manufacture;

Type of System: Wet Chemical Dry Chemical CO2….. H20

System is free of any prior discharge, damage or tampering Yes No Problems Found;

Cylinder

Pressure gauge or weight is at acceptable level. Yes No Date of last hydrostatic test of cylinder. Date;

Last date pressurized dry chemical system had chemical examined. Date;

Expellant gas cartridge; C02 psi Nitrogen pounds

Nozzles Nozzles are in proper positions Yes No

Nozzles are covered by blow-off caps Yes No

Pipe and Fittings All piping and conduit is immobilized with proper hangers and brackets Date fusible links last changed (Required Annually)

Yes No

Operation System operated properly from most remote fusible link Yes No

System operated properly from all manual actuators Yes No

Automatic shut down of fuel / power operated properly Yes No

EXHAUST SYSTEM Exhaust system ON/ Return OFF at time of activation Yes No

Final Inspection

Is system alarmed Yes No

All cooking surfaces are protected Yes No

Inspection and service tag on system cylinder Yes No

Is the hood and duct free from grease and sludge accumulation Yes No

System is now fully operational and free from obstructions Yes No

Corrections Made

This range hood system has been evaluated in accordance with manufacturer’s recommendations and NFPA standards: 96, 17 & 17A

Performance Evaluation . Name Date

Agency: Certification Number:

Address: Phone #

Signature Signature

IAW NFPA 96,17 &17A