Attachment_C_Sprinkler_System_test_form.docx
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- Attached to
- Fire Suppression, Fire Alarm, Fire Sprinkler Systems Inspection, Testing & Maintenance, JBLM, WA
- Solicitation number
- W911S8-16-R-0006
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Attachment C Sprinkler System Inspection Form
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Text version
SYSTEM #
WET FIRE SPRINKLER SYSTEM
UFC INSPECTION AND TESTING REPORT
| Date |
| Building Name |
| Time |
| Address |
| Inspector |
| City, State, Zip |
| Contact |
| Phone |
Monitoring Entity
Company
Phone
| Account |
Authority Having Jurisdiction
| Name |
| Phone |
Service: |_| 2YR |_| 5YR |_| 10YR |_| 20YR |_| 50YR
| Yes |
| No |
| N/A |
| 2 YEAR, Control Valves, operate valve through entire travel to verify function. |
| |_| |
| |_| |
| |_| |
| 2 YEAR, Control Valves, lubricate valves and stems to ensure operability. |
| |_| |
| |_| |
| |_| |
| 5 YEAR, Alarm Valve, clean and inspect internally to verify condition. |
| |_| |
| |_| |
| |_| |
| 5 YEAR, Anti-Freeze Loops, confirm correct solution mixture. |
| |_| |
| |_| |
| |_| |
| 10 YEAR, Gauges, recalibrate or replace gauges. |
| |_| |
| |_| |
| |_| |
| 20 YEAR, Fast Response Sprinklers and Extra High Temp Sprinkler, test a sample to verify response characteristics |
| |_| |
| |_| |
| |_| |
| 50 YEAR, Standard Sprinkler, replace or test a sample to verify response characteristics. |
| |_| |
| |_| |
| |_| |
| System riser location |
| Size |
| Make |
| Model |
| Waterflow test results |
| Main Drain Size |
| Static |
| Residual |
| Restore |
| Antifreeze system solution test results? |
| Degrees |
Problems Found:
Corrections Made:
Comments:
This Testing Was Performed In Accordance With Applicable Standards
Inspector
Certificate
| Date |
| Time |
Inspector Signature
| Site Representative |
| Date |
| Time |
Signature
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