B08_Atch_6_-_NPS_Standard_ITM_Forms.pdf

National Park Service Annual Inspection of Fire Detection and Notification System (Form FA-1A)

Information on this form covers the minimum requirements of NFPA 72 for fire detection and alarm systems. Separate forms are available to inspect, test an maintain other fire protection systems.

Date Previous Inspection:

Date of Inspection:

Asset ID No: Asset Description:

Park: Site No and Name:

Location ID No: Location Name:

Note: All questions are to be answered 'Yes', 'No', or 'N/A' (Non-applicable ). All 'No' answers, and additional comments, are to be explained in Part V of this form.

Part II – INSPECTION

1. Control panel fuses are satisfactory? Yes No N/A

2. Control panel interface equipment is satisfactory? Yes No N/A

3. Control panel lamps and LEDs are satisfactory? Yes No N/A

4. Control panel primary (main) power supply is satisfactory? Yes No N/A

5. Control panel trouble signals are satisfactory? Yes No N/A

6. Control panel lead-acid batteries are free of corrosion and leakage, connections are tight, and electrolyte levels is appropriate? Yes No N/A

7. Control panel nickel-cadmium batteries are free of corrosion and leakage and connections are tight? Yes No N/A

8. Control panel dry-cell primary batteries are free of corrosion and leakage and connections are tight? Yes No N/A

9. Control panel sealed lead-acid batteries are free of corrosion and leakage, connections are tight, and electrolyte level is appropriate? Yes No N/A

10. Control panel transient suppressors are satisfactory? Yes No N/A

11. Control panel trouble signals are satisfactory? Yes No N/A

12. Emergency voice/alarm communications equipment is satisfactory? Yes No N/A

13. Remote annunciators are satisfactory? Yes No N/A

14. Air-sampling initiating devices are satisfactory? Yes No N/A

15. Duct detectors are satisfactory? Yes No N/A

16. Electromechanical releasing devices are satisfactory? Yes No N/A

17. Fire extinguishing system switches are satisfactory? Yes No N/A

Control panel fuses are satisfactory? Yes No N/A

18. Fire suppression system switches are satisfactory? Yes No N/A

19. Fire alarm boxes are satisfactory? Yes No N/A

20. Heat detectors are satisfactory? Yes No N/A

21. Radiant energy fire detectors are satisfactory? Yes No N/A

22. Smoke detectors are satisfactory? Yes No N/A

23. Supervisory signal devices are satisfactory? Yes No N/A

24. Water flow devices are satisfactory? Yes No N/A

25. Video image smoke and fire detectors are satisfactory? Yes No N/A

26. Projected beam smoke detectors are satisfactory? Yes No N/A

27. Guard’s tour equipment is satisfactory? Yes No N/A

28. Interface equipment is satisfactory? Yes No N/A

29. Alarm notification appliances are satisfactory? Yes No N/A

Part III – TESTING

30. Control equipment receives correct receipt of alarm?

31. Control equipment alarm notification appliances are satisfactory? Yes No N/A

32. Control equipment interface equipment passed simulation test? Yes No N/A

33. Control equipment lamps and LEDs are illuminated? Yes No N/A

34. Control equipment primary power supply passed test by disconnecting all secondary power? Yes No N/A

35. Control equipment transponders passed test? Yes No N/A

36. Engine-driven generator passed test? Yes No N/A

37. Lead-acid batteries passed charger test? Yes No N/A

38. Lead-acid batteries passed 30-minute discharge test? Yes No N/A

39. Lead-acid batteries passed load voltage test? Yes No N/A

40. Lead-acid batteries passed specific gravity test? Yes No N/A

41. Nickel-cadmium batteries passed 30-minute discharge test? Yes No N/A

42. Nickel-cadmium batteries passed load voltage test? Yes No N/A

43. Dry-cell batteries passed load voltage test? Yes No N/A

44. Sealed lead-acid batteries passed charger test? Yes No N/A

45. Sealed lead-acid batteries passed 30-minute discharge test? Yes No N/A

46. Sealed lead-acid batteries passed load voltage test? Yes No N/A

47. Emergency voice/alarm communications equipment passed tests? Yes No N/A

48. Remote annunciators passed test and are operating properly? Yes No N/A

49. Duct smoke detectors are properly sampling the airstream? Yes No N/A

50. Correct operation of Electromechanical Releasing devices was verified by removing the fusible link and operating the associated drive? Yes No N/A

51. Fire extinguishing system switches were operated and receipt of signal by the control panel was verified? Yes No N/A

52. Fire detectors passed test and are operating at the proper sensitivity and alarm response? Yes No N/A

53. Heat detectors passed test and are operating properly? Yes No N/A

54. Fire alarm boxes passed test and are operating properly? Yes No N/A

55. Radiant energy fire detectors passed test? Yes No N/A

56. Horns and strobes operated properly? Yes No N/A

57. Supervisory signal devices, except tamper switches, passed test? Yes No N/A

58. Water flow devices passed test? Yes No N/A

59. Valve tamper switches passed test? Yes No N/A

60. Off-premises transmission equipment passed test? Yes No N/A

61. Guard’s tour equipment passed test? Yes No N/A

62. Interface equipment passed test? Yes No N/A

63. Special hazard equipment passed test and is operating properly? Yes No N/A

64. Sound pressure level for audible devices was measured with sound level meter? Yes No N/A

65. Sound pressure level for speakers was measured with sound level meter? Yes No N/A

66. Visible devices passed test and device locations are acceptable? Yes No N/A

Part IV – Maintenance

67. All components of the fire detection and alarm system have been maintained according to the manufacturer's instructions? Yes No N/A

Part V – Deficiency Notes and Additional Comments Any additional comments, test failures or other problems found with the fire detection and alarm system must be explained here. Also, note here any products noticed on the systems that have been the subject of a recall.

Item No. Comment

Part VI – Signatures

I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at his time was left in operational condition upon completion of this inspection except as noted in Part III above.

Contractor Information

Contractor or Representative's Name:

Company:

Company Address:

Company Phone:

Date:

NPS Information

Employee’s Name:

Employee Signature:

Park Division and/or Office:

Employee's Phone:

Date:

Annual Inspection of Fire Detection and Notification System

(Form FA-1A)

Date Previous Inspection:

Asset ID No: Description:

Park: Site:

Location No: Name:

Annual Inspection and Testing of Automatic Fire Sprinkler System - Wet Pipe (Form AS-1A)

Information on this form covers the minimum requirements of NFPA 25 for fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. Separate forms are available to inspect, test an maintain other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. These tasks include all applicable weekly, monthly and quarterly inspection, testing and maintenance tasks.

Date Previous Inspection:

Date of Inspection:

Asset ID No: Asset Description:

Park: Site No and Name:

Location ID No: Location Name:

Note: All questions are to be answered 'Yes', 'No', or 'N/A' (Non-applicable ). All 'No' answers, and additional comments, are to be explained in Part V of this form. Inspection, testing and maintenance are to be performed with water supplies (including fire pumps), in service, unless the impairment of NFPA 25 and the appropriate NPS Job Plan are followed.

Part I – GENERAL

1. Is building occupied? Yes No N/A

2. Has the occupancy classification and hazard of contents remained the same since the last inspection?

Yes No N/A

3. Are all fire protection systems in service? Yes No N/A

4. Has the system remained in service without modification since the last inspection? Yes No N/A

5. Was the system free of actuation of devices or alarms since the last inspection? Yes No N/A

Part II – INSPECTION

6. Control valves with locks or electrical supervision in correct (open or closed), position? Yes No N/A

7. Sprinkler wrench with spare sprinklers heads (at least two of each type of head found in system), located in spare head cabinet? Yes No N/A

8. Gauges ( Wet Pipe Only ) - Supply and system gauges show the same water pressure and are free from physical damage? Yes No N/A

9. Backflow prevention device valves in correct (open or closed position)? Yes No N/A

10. Backflow prevention device valves sealed, locked or supervised and accessible? Yes No N/A

11. Backflow prevention device relief port RPZ device not discharging? Yes No N/A

12. Pressure Reducing Valves: In open position, not leaking, maintaining downstream pressure per design criteria, and in good condition with hand wheels not broken? Yes No N/A

13. Hydraulic nameplate (calculated systems), securely attached to riser and legible? Yes No N/A

14. Hydraulic nameplate (calculated systems), securely attached to riser and legible? Yes No N/A

15. Fire Department Connections: Visible, accessible, couplings and swivels not damaged and rotate smoothly, plugs or caps in place and in good condition, identification signs(s) in place, check valve is not leaking, clapper is in place and operating properly and automatic drain valve in place and operating properly (if plugs or caps are not in place, inspect interior for obstructions)?

Yes No N/A

16. Alarm notification device (bell/horn), free from physical damage and obstruction? Yes No N/A

17. Visible sprinklers free from corrosion? Yes No N/A

18. Visible sprinklers free of obstructions? Yes No N/A

19. Visible sprinklers free o foreign materials including paint? Yes No N/A

20. All visible glass bulb sprinklers contain their heat sensitive liquid within bulb? Yes No N/A

21. Visible pipe In good condition, no external corrosion? Yes No N/A

22. Visible pipe has no mechanical damage and no leaks? Yes No N/A

23. Visible pipe properly aligned and has no external loads (wires, decorations, clothing hangers, etc.), applied? Yes No N/A

24. Visible pipe hangers and seismic braces not damaged or loose? Yes No N/A

25. Hose, hose couplings and nozzles on sprinkler system passed inspection in accordance with NFPA 1962? Yes No N/A

26. Adequate heat in areas with wet piping? Yes No N/A

27. Has an internal inspection of the pipe been performed by removing the flushing connection and one sprinkler near the end of the branch line within the last 5 years (if the answer is "No" conduct an internal inspection)?

Yes No N/A

28. Check valves internally inspected and all parts operate properly, move freely and are in good condition? Yes No N/A

29. Strainers filters, restricted orifices and diaphragm chambers on dry-pipe valves in good condition? Yes No N/A

30. Mechanical waterflow alarm devices passed tests by opening the inspector's test connection or bypass connection with alarms actuating and flow observed? Yes No N/A

Part III – FIFTH YEAR ONLY INSPECTION ( in addition to above items )

31. Check valves internally inspected and all parts operate properly, move freely and are in good condition? Yes No N/A

32. Strainers filters, restricted orifices and diaphragm chambers on dry-pipe valves in good condition? Yes No N/A

Part IV – ANNUAL TESTING

33. Mechanical waterflow alarm devices passed tests by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

Yes No N/A

34. Post indicating valves opened until spring or torsion is felt in the rod, then closed back one-quarter turn?

Yes No N/A

35. Main drain test of system downstream of backflow prevention device or pressure reducing valve - Static Pressure (psi).

_______ psi

36 . Main drain test of system downstream of backflow prevention device or pressure reducing valve - Residual Pressure (psi).

_______ psi

37. Was flow observed? Yes No N/A

38. Are results comparable to previous tests? Yes No N/A

39. Electrical waterflow alarm devices passed test by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

Yes No N/A

40. Are all sprinkler dated 1920 or later? Yes No N/A

41. Fast response sprinklers 20 or more years old replaced or successfully sample tested within last 10 years?

Yes No N/A

42. Standard response sprinklers 50 or more years old replaced or successfully sample tested within last 10 years?

Yes No N/A

43. Standard response sprinklers 75 or more years old replaced or successfully sample tested within last 5 years?

44. Dry-type sprinklers replaced or successfully sample tested within last 10 years? Yes No N/A

45. All control valves operated through full range and returned to normal position? Yes No N/A

46. Backflow devices passed backflow test? Yes No N/A

47. Backflow devices passed full flow test? Yes No N/A

48. Pressure reducing valves passed partial flow test? Yes No N/A

Part IV – THIRD YEAR TESTING ( test to be done every third year )

49. Hose (more than 5 years old), connected to the system has been service tested in accordance with NFPA 1962. Water discharged and waterflow alarms operated? Yes No N/A

Part IVb – FIFTH YEAR TESTING ( test to be done every fifth year )

50. Sprinkler(s) rated above High temperature tested? Yes No N/A

51. Gauges checked by calibrated gauge or replaced? Yes No N/A

52. Pressure reducing valves passed full flow test? Yes No N/A

Part V – MAINTENANCE

53. If sprinklers have been replaced, were they proper replacements? Yes No N/A

54. Used hose was cleaned, drained and dried before being placed back in service?

Hose exposed to hazardous materials was disposed of or decontaminated in an approved manner?

Yes No N/A

55. Systems normally filled with fresh water were drained and refilled twice if raw water got into the system?

Yes No N/A

56. If defective intake screen on pump with suction from open sources was discovered, was an obstruction investigation conducted?

Explain reason(s) and obstruction investigation findings in Part III.

Yes No N/A

57. If obstructive material discharged during waterflow tests was discovered, was an obstruction investigation conducted? Yes No N/A

58. If foreign materials were found in dry-pipe valves, check valves or pumps was an obstruction investigation conducted? Yes No N/A

59. If foreign material in water during drain test or plugging of inspector's test was discovered, was an obstruction investigation conducted? Yes No N/A

60. If plugging of pipe or sprinkler found during activation or alteration was discovered, was an obstruction investigation conducted? Yes No N/A

61. If failure to flush yard piping or surrounding public mains following new installation or repairs was discovered, was an obstruction investigation conducted? Yes No N/A

62. Is their record or history of broken water mains in the vicinity? Yes No N/A

63. If foreign materials were found in dry-pipe valves, check valves or pumps was an obstruction investigation conducted? Yes No N/A

64. Is there a practice of seasonal shut-down of system where system is returned to service after an extended period out or service? Yes No N/A

65. Is there reason to believe the system contains sodium silicate or its derivatives of highly corrosive fluxes in copper pipe system? Yes No N/A

66. If conditions were found that required flushing was flushing of system conducted? Yes No N/A

67. Operating stem of all OS&Y valves lubricated, completely closed, and replaced? Yes No N/A

68. Sprinklers and spray nozzles protecting commercial cooking equipment and ventilating systems replaced, except for bulb-type which show no signs of grease buildup?

Yes No N/A

Part VI – Deficiency Notes and Additional Comments

Any deficiencies found, or other site or system specific problems, or general comments or concerns must be explained here.

Also, note here any products noticed on the systems that have been the subject of a recall.

Item No Comment

Part VII – Signatures

I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at his time was left in operational condition upon completion of this inspection except as noted in Part III above.

Contractor Information

Representative's Name:

Company:

Company Address:

Company Phone:

Signature:

Date:

NPS Information

Employee’s Name:

Park Division and Office:

Phone Number:

Employee’s Signature:

Automatic Fire Sprinkler System - Wet Pipe (Form AS-1A)

Date Previous Inspection:

Asset ID No:

Description:

Park: Site:

Location No: Name:

Automatic Fire Sprinkler System - Dry Pipe (Form AS-2A)

Information on this form covers the minimum requirements of NFPA 25 for fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. Separate forms are available to inspect, test an maintain other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. These tasks include all applicable weekly, monthly and quarterly inspection, testing and maintenance tasks.

Date Previous Inspection:

Date of Inspection:

Asset ID No: Asset Description:

Park: Site No and Name:

Location ID No: Location Name:

Note: All questions are to be answered 'Yes', 'No', or 'N/A' (Non-applicable ). All 'No' answers, and additional comments, are to be explained in Part V of this form. Inspection, testing and maintenance are to be performed with water supplies (including fire pumps), in service, unless the impairment of NFPA 25 and the appropriate NPS Job Plan are followed.

Part I – GENERAL

1. Is building occupied? Yes No N/A

2. Has the occupancy classification and hazard of contents remained the same since the last inspection?

Yes No N/A

3. Are all fire protection systems in service? Yes No N/A

4. Has the system remained in service without modification since the last inspection? Yes No N/A

5. Was the system free of actuation of devices or alarms since the last inspection? Yes No N/A

Part II – INSPECTION

6. Control valves with locks or electrical supervision in correct (open or closed), position? Yes No N/A

7. Dry-pipe valve enclosure maintaining a minimum of 40 degrees Fahrenheit and gauges in good condition showing normal air and water pressure? Yes No N/A

8. Dry-pipe valve free form physical damage, trim valves in appropriate (opened or closed) position, no leakage from valve seat, and all electrical components in service? Yes No N/A

9. Backflow prevention device valves in correct (open or closed position)? Yes No N/A

10. Backflow prevention device valves sealed, locked or supervised and accessible? Yes No N/A

11. Backflow prevention device relief port RPZ device not discharging? Yes No N/A

12. For freezer systems, is the gauge near the compressor reading the same as the gauge near the pre-action valve? Yes No N/A

13. Sprinkler wrench with spare sprinklers heads (at lest two of each type of head found in system), located in spare head cabinet? Yes No N/A

14. Hydraulic nameplate (calculated systems), securely attached to riser and legible? Yes No N/A

15. Pressure Reducing Valves: In open position, not leaking, maintaining downstream pressure per design criteria, and in good condition with hand wheels not broken? Yes No N/A

16. Fire Department Connections: Visible, accessible, couplings and swivels not damaged and rotate smoothly, plugs or caps in place and in good condition, identification signs(s) in place, check valve is not leaking, clapper is in place and operating properly?

Yes No N/A

17. Alarm notification device (bell/horn), free from physical damage and obstruction? Yes No N/A

18. Visible sprinklers free from corrosion? Yes No N/A

19. Visible sprinklers free of obstructions? Yes No N/A

20. Visible sprinklers free o foreign materials including paint? Yes No N/A

21. All visible glass bulb sprinklers contain their heat sensitive liquid within bulb? Yes No N/A

22. Visible pipe In good condition, no external corrosion? Yes No N/A

23. Visible pipe has no mechanical damage and no leaks? Yes No N/A

24. Visible pipe properly aligned and has no external loads (wires, decorations, clothing hangers, etc.), applied? Yes No N/A

25. Visible pipe hangers and seismic braces not damaged or loose? Yes No N/A

26. Dry-pipe valve(s) passed internal inspection? Yes No N/A

27. Adequate heat in areas with wet piping? Yes No N/A

28. Low temperature alarms functioning?

29. Interior of pipe through freezers free of ice blockage? Yes No N/A

30. Has an internal inspection of the pipe been performed by removing the flushing connection and one sprinkler near the end of the branch line within the last 5 years (if the answer is "No" conduct an internal inspection)?

Yes No N/A

31. Check valves internally inspected and all parts operate properly, move freely and are in good condition? Yes No N/A

32. Strainers filters, restricted orifices and diaphragm chambers on dry-pipe valves in good condition? Yes No N/A

33. Mechanical waterflow alarm devices passed tests by opening the inspector's test connection or bypass connection with alarms actuating and flow observed? Yes No N/A

Part III – FIFTH YEAR ONLY INSPECTION ( in addition to above items )

34. Check valves internally inspected and all parts operate properly, move freely and are in good condition? Yes No N/A

35. Strainers filters, restricted orifices and diaphragm chambers on dry-pipe valves in good condition? Yes No N/A

Part IV – TESTING

36. Mechanical waterflow alarm devices passed tests by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

Yes No N/A

37. Post indicating valves opened until spring or torsion is felt in the rod, then closed back one-quarter turn?

Yes No N/A

38. Is the priming level correct and has the low air pressure signal passed its test? Yes No N/A

39. Main drain test of system downstream of backflow prevention device or pressure reducing valve - Annotate Static Pressure (psi).

_______ psi

40 . Main drain test of system downstream of backflow prevention device or pressure reducing valve - Annotate Residual Pressure (psi).

_______ psi

41. Was flow observed? Yes No N/A

42. Are results comparable to previous tests? Yes No N/A

43. Electrical waterflow alarm devices passed test by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

Yes No N/A

44. Are all sprinkler dated 1920 or later? Yes No N/A

45. Fast response sprinklers 20 or more years old replaced or successfully sample tested within last 10 years?

Yes No N/A

46. Standard response sprinklers 50 or more years old replaced or successfully sample tested within last 10 years?

Yes No N/A

47. Standard response sprinklers 75 or more years old replaced or successfully sample tested within last 5 years?

Yes No N/A

48. Dry-type sprinklers replaced or successfully sample tested within last 10 years? Yes No N/A

49. All control valves operated through full range and returned to normal position? Yes No N/A

50. Low temperature alarms passed test? Yes No N/A

51. Dry-pipe valve(s) partial flow trip test - Annotate initial air pressure and water pressure (psi).

_______ psi

52. Dry-pipe valve(s) partial flow trip test - Annotate tripping pressure air pressure and tripping time (sec.)

_______ sec

53. Dry-pipe valve(s) partial flow trip test recorded pressures and times comparable to design values? Yes No N/A

54. Automatic air maintenance device passed test Yes No N/A

55. Backflow devices passed backflow test? Yes No N/A

56. Backflow devices passed full flow test? Yes No N/A

57. Pressure reducing valves passed partial flow test? Yes No N/A

Part IVa – TESTING ( test to be done every fifth year )

58. Dry-pipe full flow trip test record initial air pressure _______ (psi), and w ater pressure _______ (psi).

59. Dry-pipe full flow trip test record tripping air pressure _______ (psi), and tripping time _______ (sec.)

60. Dry-pipe full flow trip test record water delivery time _______ (min.), and tripping time _______ (sec.).

61. Dry-pipe full flow trip test above results comparable to design values? Yes No N/A

Part V – MAINTENANCE

62. If sprinklers have been replaced, were they proper replacements? Yes No N/A

63. Any air leaks in dry-pipe system resulting in air pressure loss more than 10 psi/week repaired?

64. Dry-pipe systems maintained in dry condition? Yes No N/A

65. Have low point drains been emptied? Yes No N/A

66. If defective intake screen on pump with suction from open sources was discovered, was an obstruction investigation conducted?

Explain reason(s) and obstruction investigation findings in Part VI.

Yes No N/A

67. If obstructive material discharged during waterflow tests was discovered, was an obstruction investigation conducted? Yes No N/A

68. If foreign materials were found in dry-pipe valves, check valves or pumps was an obstruction investigation conducted? Yes No N/A

69. If foreign material in water during drain test or plugging of inspector's test was discovered, was an obstruction investigation conducted? Yes No N/A

70. If plugging of pipe or sprinkler found during activation or alteration was discovered, was an obstruction investigation conducted? Yes No N/A

71. If failure to flush yard piping or surrounding public mains following new installation or repairs was discovered, was an obstruction investigation conducted? Yes No N/A

72. Is their record or history of broken water mains in the vicinity? Yes No N/A

73. If foreign materials were found in dry-pipe valves, check valves or pumps was an obstruction investigation conducted? Yes No N/A

74. Is there a practice of seasonal shut-down of system where system is returned to service after an extended period out or service? Yes No N/A

75. Is there reason to believe the system contains sodium silicate or its derivatives of highly corrosive fluxes in copper pipe system? Yes No N/A

76. If conditions were found that required flushing was flushing of system conducted? Yes No N/A

77. Operating stem of all OS&Y valves lubricated, completely closed, and replaced? Yes No N/A

78. Interior of dry-pipe valves cleaned? Yes No N/A

79. Low points drained prior to the onset of freezing weather? Yes No N/A

80. Sprinklers and spray nozzles protecting commercial cooking equipment and ventilating systems replaced, except for bulb-type which show no signs of grease buildup?

Part VI – Deficiency Notes and Additional Comments

Any deficiencies found, or other site or system specific problems, or general comments or concerns must be explained here. Also, note here any products noticed on the systems that have been the subject of a recall.

Item No Comment

Part VII – Signatures

I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at his time was left in operational condition upon completion of this inspection except as noted in Part III above.

Contractor Information:

Representative's Name:

Company:

Company Address:

Company Phone:

Date:

NPS Information:

Employee’s Name:

Division and Office:

Phone Number:

Automatic Fire Sprinkler System - Dry Pipe (Form AS-2A)

Previous Inspection:

Asset ID No: Description:

Park: Site No and Name:

Location No: Name:

Asset Work Order Summary (If not data appears below there are no active work order in FMSS for this Asset)

Residential Fire Protection System Annual Inspection and Testing Form (Form RFP-1)

Location No.

Park: Site No. and Park Name:

Location Description:

Sq. Ft.:

Occupancy Type: Tenant Type:

Location Type: Rental Class:

Instructions: Inspection must be completed annually, and the results uploaded to the NPS Structural Fire Data Management System (SFDMS). Where a violation is discovered, and cannot be immediately corrected to the inspector ’s satisfaction, a check mark shall be placed in the 'No’ column. The inspector shall provide comment on all 'No' observations; describing the deficiency identified and recommended corrective action.

Smoke Alarms

Item No. Observation Yes No N/A

1 Does each bedroom have a smoke alarm installed on the ceiling/wall?

Does the common corridor leading to each bedroom have a smoke alarm installed on the ceiling/wall?

Are all smoke alarms in place and properly connected to the device base and the ceiling/wall?

Where smoke alarms are hard-wired to unit AC power, is circuit powering the fire sprinkler bell or horn identified as 'Fire Sprinkler Bell/Horn' in circuit panel

Have all smoke alarms been tested for proper operation:

1. Single Station: Activation of one device does not activate others

2. Interconnected: All devices sound simultaneously when any one device is activated

6 Are smoke alarms free of physical damage?

Carbon Monoxide Detectors (Required for attached garages, or where fuel-fired appliances are installed)

Item No. Observation Yes No N/A

Are there carbon monoxide detectors installed outside of each bedroom door?

If the unit has a basement, are there carbon monoxide detectors installed in the basement?

Carbon monoxide detectors are properly connected to the device base and the ceiling/wall, and free of physical damage?

Carbon monoxide detectors are not

'required' to be installed near the floor.

10 Did carbon monoxide detectors work when tested?

11 Were detectors inspected for physical damage?

Where carbon monoxide detector is plugged in to a wall outlet, is that outlet labeled 'CO Detector' in circuit panel?

Fire Extinguishers

Item No. Observation Yes No N/A

13 If a fire extinguisher present?

14 Is the fire extinguisher properly mounted and secured?

15 Does fire extinguisher appear to be free of physical damage?

16 Does fire extinguisher gauge show in the green?

If there is an attached garage, is a separate fire extinguisher installed in the garage?

Fire Sprinkler System

Item No. Observation Yes No N/A

Visually inspected all accessible sprinklers to ensure they are not blocked, being used to support decorations or wiring, and are not leaking or damaged?

Are all valves controlling water supply to the fire sprinkler system open and secured in the open position?

Verify designed static pressure (from hydraulic design placard, if available), and record static water pressure on riser gauge?

Record Static Pressure

Did system water flow switch activate local notification appliance (bell or horn), when water was flowed?

Is circuit powering the fire sprinkler system notification appliance (bell or horn), identified as 'Fire Sprinkler Bell/Horn' in circuit panel?

Self-contained System: Verify and record water level of any on-site water tank which solely supports the fire sprinkler system?

Record Tank Volume

Self-contained Systems: Verify and record fire sprinkler pump (if applicable, is fully operational and does not trip circuit breakers in operation?

Self-contained Systems: Is circuit powering the sprinkler system water pump identified as 'Fire Sprinkler Water Pump' in circuit panel?

Deficiency Comments and Recommended Corrective Actions

Item No.

Signatures

Tenant's Name: Park Inspector's Name:

Signature: Signature:

Date: Date:

Residential Fire Protection System Annual Inspection and Testing Form (Form RFP-1)

Location No: Location Description :

Park: Site No and Park Name:

Sq. Ft.: Occupancy Type: Tenant Type:

Historic: Year Built:

Work Order History Summary

Date Work Order: Work Order Status: Date of Last Change:

Work Order Description: