B08_Attachment_6_-_Dry_Chemical_Test_Form.pdf

Dry Chemical Suppression System Page 1 of 3 Revised 12/16/15

National Park Service / AKRO

Inspection and Test Report (complete a separate form for each system)

DRY CHEMICAL SUPPRESSION SYSTEM

Park Alpha Code: _________

Location Description : ______________________

Date of Test:_________________________

Time:_________________

System Make: ______________________ System Model: _____________________

No of Agent Cylinders ______________________ No. of Nozzles _____________________

DEFICIENCIES FOUND? Yes No List items that were not corrected. Use the Deficiencies section or attach itemized sheet

REPAIRS: All deficiencies have been corrected N/A Yes No

This certifies that the fire and life safety system has been inspected and tested for functional operation in accordance with NFPA 17, and has been properly tagged and/or labeled. Any discrepancies found are noted in this report with code references for corrective action by the Owner/Responsible Person.

Technician Name (printed): ______________________ Company: ______________________________

Signature: ___________________________________ Phone #: _______________________________

State Certification No.: _________________________ National/NICET No.: ______________________

COVERAGE , NOZZLES, AND PIPING

1. The area/hazard to be protected has the required number and type of nozzles to provide adequate fire protection.

Yes No

2. All nozzles are properly positioned. Yes No

3. Piping is installed and supported adequately with no evidence of damage Yes No

4. Fusible link cable conduits are immobilized with proper hangers and brackets. Yes No

SYSTEM CONTROLS

5. All system controls and components are accessible and free from obstructions. Yes No

6. The system is operational from the test link (last fusible link) Yes No

7. All fusible links have been replaced and the year of manufacture and date of installation is marked on the system inspection tag.

Yes No

8. Manual release station(s) are readily accessible, located 42” – 48” above the floor, and identify the hazard they protect

Yes No

9. Manual release stations are configured correctly and operational. Yes No

10. The operation of the fusible link line is not impaired by debris or foreign materials. Yes No

11. Where the system protects a hazard with flowing flammable or combustible fluids or gases, an automatic means to shutoff the fuel upon operation of the extinguishing system is provided.

N/A Yes No

12. Equipment and/or fuel shutoff interlock(s) were tested and are operational N/A Yes No

13. Warning signs are installed where there is a possibility that personnel could be exposed to a dry chemical discharge.

N/A Yes No

Karma Torres Text Box Asset No.:

Karma Torres Line

Karma Torres Snapshot

Karma Torres Line

Karma Torres Line

Dry Chemical Suppression System Page 2 of 3 Revised 12/16/15

CYLINDERS AND EXTINGUISHING AGENT

14. The extinguishing agent in the cylinders conforms to the manufacturer’s requirements for this system.

Yes No

15. Storage cylinders are fastened securely to their mounting brackets. Yes No

16. The cylinders are filled with the correct volume of extinguishing agent.

Required volume ________lbs. or __________gals.

Yes No

17. The cylinder gauge is in the operational range. Yes No

18. The CO2 or Nitrogen cylinder is fully charged.

Design weight _____ lb. Actual Weight _____lb.

N/A Yes No

19. The hydrostatic testing of the agent cylinder(s) is up-to-date.

Date for next hydrostatic test ______________________

N/A Yes No

MONITORING

20. The system is connected to the fire alarm system. (if an alarm panel exists) N/A Yes No

21. The fire alarm panel receives the proper signals upon suppression system activation.

N/A Yes No

22. The alarm monitoring company received the alarm signal. N/A Yes No

Dry Chemical Suppression System Page 3 of 3 Revised 12/16/15

Deficiencies

Resolved

Location:

Deficiency:

Recommended Resolution:

NFPA 17 reference: