Attachment_A_Fire_Alarm_Inspection_&_Testing_form.docx

“Company Name”

FIRE ALARM SYSTEMS

ITM REPORT/SPRINKLER

JBLM, WASHINGTON

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.

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

Pull Stations

Sync Module

Smoke Detectors

Duct Detectors

Monitor Modules

PRIOR TO ANY TESTING

N/A

FACP System Power Supplies

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.

Battery Calculation Unavailable: Cannot determine system operation design hours

FACP Batteries

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

Transmitter Batteries

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #1 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #2 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #3 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #4 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #5 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

|X| |_|

Standby Voltage:

|X| |_|

Charge Voltage:

|X| |_|

Install date:

Manufacturer date:

BPS #6 Batteries: Locaction AC Pwr Bkr:

Load Voltage After 5 minute alarm:

Standby Voltage:

Charge Voltage:

Install date:

Manufacturer date:

Sprinkler Solenoid Information

System Test and Inspections

Alarm Notification Appliances Information

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

Type Visual Check Functional Check Factory Setting Measured Setting

Type Visual Check Functional Check Factory Setting Measured Setting

Duct Detector was cleaned by Tech: ________________________________ Date: ________________

Sprinkler Solenoid Information

Mass Notification Test

1. During Activation of all MN messages from ACU / LOC:

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:

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

Findings: ___________________________________

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

LOC #1

B. Message nameplate on panel(s)

Findings: ____________________________________

4. JBECC MNS Operations:

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

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:

For “Name of Company” control only Building # Master FA Report 8-9-16