Attachment_B_Kitchen_hood_suppression_form.doc
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- Fire Suppression, Fire Alarm, Fire Sprinkler Systems Inspection, Testing & Maintenance, JBLM, WA
- Solicitation number
- W911S8-16-R-0006
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Attachment B Kitchen Hood Inspection Form
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Fire and Emergency Services
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;
FORMTEXT
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Type of System: Wet Chemical FORMCHECKBOX Dry Chemical FORMCHECKBOX
CO2….. FORMCHECKBOX
H20 FORMCHECKBOX
| System is free of any prior discharge, damage or tampering |
| FORMCHECKBOX |
Yes FORMCHECKBOX No
Problems Found;
FORMTEXT
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| Cylinder |
| Pressure gauge or weight is at acceptable level. |
| FORMCHECKBOX |
| Date of last hydrostatic test of cylinder. |
| Date; |
| Last date pressurized dry chemical system had chemical examined. |
| Date; |
Expellant gas cartridge; C02 FORMCHECKBOX psi Nitrogen FORMCHECKBOX pounds
| Nozzles |
| Nozzles are in proper positions |
| FORMCHECKBOX |
| Nozzles are covered by blow-off caps |
| FORMCHECKBOX |
Yes FORMCHECKBOX No
| Pipe and Fittings |
| All piping and conduit is immobilized with proper hangers and brackets |
Date fusible links last changed (Required Annually)
FORMCHECKBOX
Yes FORMCHECKBOX No
FORMTEXT
FORMTEXT
| Operation |
| System operated properly from most remote fusible link |
| FORMCHECKBOX |
| System operated properly from all manual actuators |
| FORMCHECKBOX |
| Automatic shut down of fuel / power operated properly |
| FORMCHECKBOX |
Yes FORMCHECKBOX No
| EXHAUST SYSTEM |
| Exhaust system ON/ Return OFF at time of activation |
| FORMCHECKBOX |
Yes FORMCHECKBOX No
| Final Inspection |
| Is system alarmed |
| FORMCHECKBOX |
| All cooking surfaces are protected |
| FORMCHECKBOX |
| Inspection and service tag on system cylinder |
| FORMCHECKBOX |
| Is the hood and duct free from grease and sludge accumulation |
| FORMCHECKBOX |
| System is now fully operational and free from obstructions |
| FORMCHECKBOX |
Yes FORMCHECKBOX 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
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