W911SA25QA133 Technical Exhibits Attachments 07-01 through 07-15.pdf

63rd Readiness Division Fire Protection Systems

Deluge Fire Sprinkler Systems

Report of Annual Inspection, Testing & Maintenance of Fire Sprinkler Systems

ONE REPORT SHALL BE COMPLETED FOR EACH SYSTEM

(Weekly, Monthly, Quarterly, and Bi-Annual Inspection Tasks are included in this report)

FACID

Building Number

Date of Inspection

System Number or Location

Location of the System Riser Manufacturer of system Size of system Model of system Year of Manufacture Operation (Pneumatic, Electric, Hydraulic)

Date of Last Full Flow Trip Test Number of Low Point Drains on System

Complete the remainder of this page once inspection is complete.

IV. Annual Deluge Sprinkler System NFPA 25 Inspection Summary:

Y N

Deluge sprinkler system considered acceptable based on inspection and performance tests Deficiencies and corrections needed are noted in comments section or attached

Comments:

Annual NFPA 25 Deluge Fire Sprinkler System Inspection

I. Inspection Tasks:

Y N/A N

Fire sprinkler system appears to be in service at time of inspection Date of last 5 year inspection Date of last Obstruction Inspection System Riser:

This system is clearly marked indicating the area served Records of tripping time maintained for previous full flow trip tests Tag or card showing trip test date and name of person and organization conducting test attached to deluge pipe valve

Separate records of initial air and water pressure, tripping air pressure, and deluge pipe valve operating conditions maintained on premises for comparison

Hydraulic information sign provided at riser and is legible Deluge system trim valves are in appropriate open or closed position System valves and equipment free of physical damage System valves, equipment, and drains not leaking Alarm device free from physical damage Spare sprinklers are of proper number (at least 6), type and temperature rating Spare sprinklers stored where temperature maximum is 100°F Wrench available for each type of sprinkler installed in this system The riser room or valve location is heated to at least 40°F Valves:

Control valve(s) completely open Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Supply pressure gauge psi System pressure gauge psi Quick opening device gauge (if applicable) psi Air compressor gauge (if applicable) psi Gauge readings appear normal General System Observations (All observations taken from the floor. NFPA 25 does not require the inspector to enter any concealed spaces or leave the floor for these activities.)

Sprinklers:

Sprinklers appear free of leakage Sprinklers appear free of corrosion Sprinklers appear free of foreign materials Sprinklers appear free of paint Sprinklers appear free of physical damage Sprinklers appear properly oriented Sprinkler spray patterns appear free of obstructions Glass bulbs in applicable fire sprinklers appear full of liquid

I. Inspection Tasks (cont.):

Y N/A N

Piping & Fittings: (visible from the floor only) Deluge system is free of air pressure leaks greater than 10psi/week Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion Piping appears properly aligned Piping free of external loading (not supporting other equipment) Hangers: (visible from the floor only) Hangers and seismic bracing appear to be in good condition (paint or coatings in place/undamaged, no rust or corrosion)

Hangers and seismic bracing appear securely attached to structural members and piping

Hangers and seismic bracing appear undamaged and not missing

II. Maintenance & Testing:

General: Y N/A N

All portions of this system appear to be in service prior to maintenance and testing Alarm monitoring service and all pertinent parties notified before performing maintenance or testing

Control Valves:

Control valves (including backflow and PIVs) operated through full range and returned to normal position

Operating stems of OS&Y valves lubricated PIVs opened until spring or torsion felt in rod PIVs and OS&Ys backed 1/4 turn from full open Supervisory switches initiated distinct signal during first two hand wheel revolutions or before valve stem moved one-fifth from normal position

Signal restored only when control valve returned to normal position Deluge Valve and System Components:

Deluge pipe valve interior thoroughly cleaned and inspected Grease or other sealing materials were not applied or present on the seating surfaces of Deluge pipe valve

Priming water level checked Quick opening device(s) tested Low pressure alarm tested Automatic air pressure maintenance devices tested in accordance with mfg. inst.

Air Compressor tank drained Deluge pipe system low points drained Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale System gauges recalibrated or replaced as necessary

Yes - Replaced

Yes - Recalibrated

Foam Tests:

Have samples of the foam-water concentrate been taken during full flow testing and checked to verify concentration is within % of acceptance test results?

Do the foam-water spray nozzles in place appear to be pointed in the direction per system design and free from external loading and corrosion at the time of inspection?

Were caps or plugs that are required in place at time of inspection?

Have all known system low points and drum drips been drained and inspected?

If applicable, was the foam concentrate pump operated and did the foam concentrate appear to be circulated back to tank?

Have the foam liquid tank pickup pipes been inspected for corrosion, separation and plugging?

Verify that the ball drip valves (automatic drain), if accessible, are free and opened, and the foam concentrate storage tank(s) is free of external corrosion.

All pressure shall be removed before inspection to prevent injury Does the monitor nozzle(s) appear to be free of any leaking, corrosion, or physical damage at the time of inspection?

Does monitor nozzle(s) oscillate and move throughout its preset full range at the time of inspection?

Select the method below used for the Inspector’s Test

Using remote inspectors test connection Bypass connection Per manufacturer's instructions

III. Completion:

Deluge system restored and left in service Date Time

Inspector Name

Signature

Witness

System Tests: Y N/A N

Main Drain Test Conducted Trip Test Conducted (select type of test conducted below)

Full Flow Test (must be conducted every 3 years) Partial Trip

Where the Deluge pipe valve is protecting freezers, trip tested in manner not introducing moisture into piping inside the freezer.

Water flow alarm tested and is operational

Deluge Fire Sprinkler Systems

Report of Annual Inspection, Testing & Maintenance of Fire Sprinkler Systems

ONE REPORT SHALL BE COMPLETED FOR EACH SYSTEM

(Weekly, Monthly, Quarterly, and Bi-Annual Inspection Tasks are included in this report)

FACID

Building Number

Date of Inspection

System Number or Location

Location of the System Riser Manufacturer of system Size of system Model of system Year of Manufacture Operation (Pneumatic, Electric, Hydraulic)

Date of Last Full Flow Trip Test Number of Low Point Drains on System

Complete the remainder of this page once inspection is complete.

IV. Annual Deluge Sprinkler System NFPA 25 Inspection Summary:

Y N

Deluge sprinkler system considered acceptable based on inspection and performance tests

I. Inspection Tasks:

Y N/A N

Fire sprinkler system appears to be in service at time of inspection Date of last 5 year inspection Date of last Obstruction Inspection System Riser:

This system is clearly marked indicating the area served Records of tripping time maintained for previous full flow trip tests test attached to deluge pipe valve

Separate records of initial air and water pressure, tripping air pressure, and deluge pipe valve operating conditions maintained on premises for comparison

Deluge system trim valves are in appropriate open or closed position System valves and equipment free of physical damage System valves, equipment, and drains not leaking Alarm device free from physical damage Spare sprinklers are of proper number (at least 6), type and temperature rating Spare sprinklers stored where temperature maximum is 100°F Wrench available for each type of sprinkler installed in this system The riser room or valve location is heated to at least 40°F Valves:

Control valve(s) completely open Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Supply pressure gauge psi System pressure gauge psi Quick opening device gauge (if applicable) psi Air compressor gauge (if applicable) psi Gauge readings appear normal General System Observations (All observations taken from the floor. NFPA 25 does not require the inspector to enter any concealed spaces or leave the floor for these activities.)

Sprinklers:

Sprinklers appear free of leakage Sprinklers appear free of corrosion Sprinklers appear free of foreign materials Sprinklers appear free of paint Sprinklers appear free of physical damage Sprinklers appear properly oriented

I. Inspection Tasks (cont.):

Piping & Fittings: (visible from the floor only) Deluge system is free of air pressure leaks greater than 10psi/week Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion Piping appears properly aligned Piping free of external loading (not supporting other equipment) Hangers: (visible from the floor only)

All portions of this system appear to be in service prior to maintenance and testing

PIVs and OS&Ys backed 1/4 turn from full open

Deluge Valve and System Components:

Deluge pipe valve interior thoroughly cleaned and inspected surfaces of Deluge pipe valve

Low pressure alarm tested Automatic air pressure maintenance devices tested in accordance with mfg. inst.

Air Compressor tank drained Deluge pipe system low points drained Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale System gauges recalibrated or replaced as necessary

Replaced

Foam Tests:

Have samples of the foam-water concentrate been taken during full flow testing and checked to verify concentration is within % of acceptance test results?

Do the foam-water spray nozzles in place appear to be pointed in the direction per system design and free from external loading and corrosion at the time of inspection?

Were caps or plugs that are required in place at time of inspection?

Have all known system low points and drum drips been drained and inspected?

If applicable, was the foam concentrate pump operated and did the foam concentrate appear to be circulated back to tank?

Have the foam liquid tank pickup pipes been inspected for corrosion, separation and plugging?

Verify that the ball drip valves (automatic drain), if accessible, are free and opened, and the foam concentrate storage tank(s) is free of external corrosion.

All pressure shall be removed before inspection to prevent injury Does the monitor nozzle(s) appear to be free of any leaking, corrosion, or physical damage at the time of inspection?

Does monitor nozzle(s) oscillate and move throughout its preset full range at the time of inspection?

Deluge system restored and left in service Date Time

Trip Test Conducted (select type of test conducted below)

Full Flow Test (must be conducted every 3 years) Partial Trip

Where the Deluge pipe valve is protecting freezers, trip tested in manner not introducing moisture into piping inside the freezer.

Diesel Fire Pump Assemblies

ONE REPORT SHALL BE COMPLETED FOR EACH PUMP

Fire Pump ID or Location

Fire Pump Information Fire Pump Manufacturer Model Rated Capacity (gpm) Rated Pressure (psi) Engine Manufacturer Horsepower Rated Speed

Controller Information Controller Manufacturer Model

VI. Annual Fire Pump Test & NFPA 25 Inspection Summary:

Fire pump assembly considered acceptable based on inspection and performance tests

Pump results charted on N1.85 graph paper and attached

Annual NFPA 25 Diesel Fire Pump Inspection & Test

Fire Pump appears to be in service at time of inspection

Suction reservoir or water storage tank is full

Enter the date of last 5year inspection (type unknown if no information is available) Enter the date of last Obstruction Inspection (type unknown if no information is available) Environment:

Pump room or pump house sufficiently heated (min 40°F) Pump room or pump house adequately illuminated Intake louvers & duct clean Valves:

Control valves completely open (Intake, Discharge, and Bypass) Test header control valve closed Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Suction gauge pressure psi

Discharge gauge pressure psi Gauge readings (suction and discharge) appear to be in expected range when pump is not operating

Diesel Fuel Tank:

Diesel fuel tank 2/3 full Diesel fuel tank vents and overflow piping free from obstructions Diesel fuel piping in good condition Fire Pump Controller:

Controller pilot light or LED screen indicates that the controller is “ON” Controller set to “AUTO” All alarm pilot lights are “OFF” Pilot lights for batteries are “ON” or battery failure pilot lights are “OFF” Pressure recorder graph paper changed (if applicable) Electrical connections appear tight (or corrected if possible) Batteries:

Electrolyte level in batteries is normal Battery terminals are free of corrosion Voltage readings for batteries (2) are normal Charging current readings are normal for batteries

I. Inspection Tasks (cont):

Fire Pump: Y N/A N

Record engine running time from meter hrs

Fire Pump appears free from physical damage Flexible hoses, connectors in good condition Fuel solenoid valve appears operational Crankcase oil level is normal Engine coolant level normal Antifreeze concentration adequate Cooling water jacket heater operational Cooling water jacket piping leak tight Lube oil heater is operational Engine block heater operational Fire Pump shaft end play within specified tolerances Fire Pump coupling alignment within specified tolerances Parallel and angular alignment of fire pump and driver checked Pump shaft end play within specified tolerances Pump coupling alignment within specified tolerances Parallel and angular alignment of pump and driver checked Flexible exhaust section inspected and in good condition Exhaust system hangers and supports in place and in good condition Jockey Pump:

Power is provided to jockey pump Hangers: (Fire Pump or Pump Room Only)

Hangers and seismic bracing appear securely attached to structural members and piping

Piping & Fittings: (Fire Pump and Pump Room Only) Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion Piping appears properly aligned Piping free of external loading (not supporting other equipment)

Valves:

Control valves operated through full range and returned to normal position Operating stems of OS&Y valves lubricated PIVs opened until spring or torsion felt in rod PIVs and OS&Ys backed 1/4 turn from full open Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale

Diesel Fuel Tank:

Diesel fuel tank float switch operational Drained approx. 5 gal of fuel from the tank sump to remove water and foreign material

Diesel fuel tested for degradation Fire Pump Controller:

Pressure switches for fire pump and jockey pump set correctly

Electrical system boxes, panels, and cabinets clean

Batteries:

Battery terminals clean and free of corrosion

Battery voltage normal (>9 volts on a 12 volt system or >18 volts on a 24 volt system)

Battery electrolyte level normal (NA for maintenance free batteries)

Battery exteriors clean and dry

Either Battery pilot light “ON” or Battery failure light “OFF”

Fire Pump:

Engine has been serviced within the last 12 months or 50hrs Cooling system condensate trap drained Exhaust condensate trap drained Pump bearing lubricated Electrical system safeties and alarms operated Electrical system boxes, panels, and cabinets cleaned Fire pump assembly maintenance performed in accordance with mfg.

recommendations (NA if this information is not provided by the owner)

Parallel and angular misalignment corrected (N/A if no correction needed) Circulation relief valve verified to close in accordance with mfg. spec.

Diesel Run Test:

Jockey Pump Turned Off Engine Starts on battery #1 from the engine control box Engine Starts on battery #2 from the engine control box Engine starts on battery #1 from the fire pump controller box Engine starts on battery #2 from the fire pump controller box No abnormal noises/vibrations observed Fire Pump operated with both primary and backup ECM Operated speed governor Exhaust system examined for leaks Intake air louvers in pump room are operational

II. Maintenance & Testing (cont.):

Engine has been serviced within the last 12 months or 50hrs Cooling system condensate trap drained Exhaust condensate trap drained Pump bearing lubricated Electrical system safeties and alarms operated Electrical system boxes, panels, and cabinets cleaned Fire pump assembly maintenance performed in accordance with mfg.

recommendations (NA if this information is not provided by the owner)

Diesel Run Test:

Jockey Pump Turned Off Engine Starts on battery #1 from the engine control box Engine Starts on battery #2 from the engine control box Engine starts on battery #1 from the fire pump controller box Engine starts on battery #2 from the fire pump controller box No abnormal noises/vibrations observed Fire Pump operated with both primary and backup ECM Operated speed governor Exhaust system examined for leaks Intake air louvers in pump room are operational

II. Annual Fire Pump Performance Tests:

Diesel Fire Pump and all equipment appear to be in service prior to the annual test Jockey Pump turned off for test Care taken to prevent water damage by verifying adequate drainage When testing with a Flowmeter and not flowing water outside, indicate the date of last test where water was flowed through the test header. (Test with flow through test header required every 3 years)

Fire Pump Churn Test:

Electric Pump starts when performing pressure drop test Pump starting pressure psi psi Record time for diesel engine to crank sec Record time for diesel engine to reach running speed sec Suction pressure gauge reading (while pump is running) psi Discharge pressure gauge reading (while pump is running) psi Packing gland discharging water (approx. 1 drip per second) if No, were packing glands adjusted (N/A if no adjustment was required) Oil pressure gauge, speed indicator, water and oil temperatures appear normal No overheating of packing box, bearings or pump casing observed No abnormal noises/vibrations observed Check heat exchanger for cooling water flow Checked packing boxes, bearings, or pump casing for overheating Circulation relief valve operational Pressure relief valve operational (if applicable) At churn, circulation relief valve checked for operation and water discharge At churn, pressure relief valve checked for proper operation At churn, pressure control valve checked for proper operation Alarms activated correctly For Fire Pump Flow Test using Flowmeter Flow meter adjusted immediately prior to testing in accordance with mfg. inst.

Test results using flow meter are consistent with previous annual test results (if “no” – complete flow test using hose streams OR calibrate flow meter)

Diesel Fire Pump Annual Flow Test Annual Fire Pump Flow Test conducted per NFPA 25 Type of device(s) used to determine flows Flow test conducted under minimum, rated, and peak fire pump flows At each flow condition, simultaneous readings of pump suction and discharge pressures and pump discharge flow recorded (see appropriate section in Section III)

At each flow condition, electric motor voltage and current in all lines recorded (see appropriate section on in Section III)

III. Test Data:

Pressure & Flow

Flow Suction

Pressure

(PSI)

Discharge

Net Pump

Pump Speed

(RPM)

Pitot

Dia. of Nozzle

Openings No. of

Nozzles Flowed

Based on Pitot Pres.

Actual

(GPM)

Churn 100% 150%

Voltage & Current

Flow Volts Amps Lead #1 Lead #2 Lead #3 Lead #1 Lead #2 Lead #3

Remarks on Test

Date of the Test Time of Test

Person Conducting the Test Company

Witness Title

IV. Annual Fire Pump Test Completion:

Fire Pump Controller returned to the "Auto" setting

Jockey pump returned to service and operates satisfactory

FIRE PUMP LEFT IN SERVICE - DATE TIME

V. Annual Test Results and Evaluation:

(This section to be completed by after evaluating results)

Pump results charted on N1.85 graph paper Pump results compared to data from previous year Fire pump operated at maximum allowable discharge (where available suction supplies do not allow flowing of 150 percent of rated pump capacity)

Fire pump suction supply provided required flow at 0 psi or higher gauge pressure at pump suction flange (except installations where NFPA 20 permitted negative suction gauge pressures)

Electric fire pump driver did not overload beyond rating (including service factor allowance) while delivering necessary brake horsepower

Theoretical rated speed correction factors not applied to determine pump compliance per testing

Engine speed not required to be increased beyond pump speed rating to achieve rated pump performance

Investigation initiated where degradation in excess of 5 percent of initial acceptance test pressure or nameplate pressure

Voltage readings at motor within 5 percent below or 10 percent above rated voltage Abnormalities observed during inspection, testing, and maintenance promptly reported to responsible party

Annual Fire Pump Flow test matches initial unadjusted field acceptance test curve Annual Fire Pump Flow matches performance characteristics on nameplate Fire pump assembly considered acceptable

Dry Pipe Fire Sprinkler Systems

Manufacturer of dry valve Size of dry valve Model of dry valve Year of Manufacture

Date of Last Full Flow Trip Test Number of Low Point Drains on System

IV. Annual Dry Fire Sprinkler System NFPA 25 Inspection Summary:

Dry fire sprinkler system considered acceptable based on inspection and performance tests

Annual NFPA 25 Dry Fire Sprinkler System Inspection

Date of last 5 year inspection Date of last Obstruction Inspection System Riser:

This system is clearly marked indicating the area served Records of tripping time maintained for previous full flow trip tests test attached to dry pipe valve

Separate records of initial air and water pressure, tripping air pressure, and dry pipe valve operating conditions maintained on premises for comparison

Dry system trim valves are in appropriate open or closed position System valves and equipment free of physical damage System valves, equipment, and drains not leaking Alarm device free from physical damage Spare sprinklers are of proper number (at least 6), type and temperature rating Spare sprinklers stored where temperature maximum is 100°F Wrench available for each type of sprinkler installed in this system The riser room or valve location is heated to at least 40°F Valves:

Control valve(s) completely open Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Supply pressure gauge psi System pressure gauge psi Quick opening device gauge (if applicable) psi Air compressor gauge (if applicable) psi Gauge readings appear normal General System Observations (All observations taken from the floor. NFPA 25 does not require the inspector to enter any concealed spaces or leave the floor for these activities.)

Sprinklers:

Sprinklers appear free of leakage Sprinklers appear free of corrosion Sprinklers appear free of foreign materials Sprinklers appear free of paint Sprinklers appear free of physical damage Sprinklers appear properly oriented

Piping & Fittings: (visible from the floor only) Dry system is free of air pressure leaks greater than 10psi/week Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion Piping appears properly aligned Piping free of external loading (not supporting other equipment) Hangers: (visible from the floor only)

PIVs and OS&Ys backed 1/4 turn from full open

Dry Valve and System Components:

Dry pipe valve interior thoroughly cleaned and inspected surfaces of dry pipe valve

Low pressure alarm tested Automatic air pressure maintenance devices tested in accordance with mfg. inst.

Air Compressor tank drained Dry pipe system low points drained Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale

Trip Test Conducted (select type of test conducted below)

Full Flow Test (must be conducted every 3 years) Partial Trip

Where the dry pipe valve is protecting freezers, trip tested in manner not introducing moisture into piping inside the freezer.

System restored and left in service Date Time

Electric Fire Pump Assemblies

ONE REPORT SHALL BE COMPLETED FOR EACH PUMP

Fire Pump ID or Location

Fire Pump Information Fire Pump Manufacturer Model Rated Capacity (gpm) Rated Pressure (psi) Voltage Rating Rated Speed

Controller Information Controller Manufacturer Model Listed (Y/N) Transfer Switch (Y/N)

VI. Annual Fire Pump Test & NFPA 25 Inspection Summary:

Fire pump assembly considered acceptable based on inspection and performance tests

Pump results charted on N1.85 graph paper and attached

Annual NFPA 25 Electric Fire Pump Inspection & Test

Fire Pump appears to be in service at time of inspection Suction reservoir or water storage tank is full Enter the date of last 5year inspection (type unknown if no information is

Enter the date of last Obstruction Inspection (type unknown if no information is

Environment:

Pump room or pump house sufficiently heated (min 40°F) Pump room or pump house adequately illuminated Valves:

Control valves completely open (Intake, Discharge, and Bypass) Test header control valve closed Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Suction gauge pressure psi Discharge gauge pressure psi Gauge readings (suction and discharge) appear to be in expected range when pump is not operating

Controller pilot light (power on) is illuminated Controller set to “AUTO” Reverse-phase alarm light is not illuminated Normal-phase rotation light is illuminated All alarm pilot lights are “OFF” Pressure recorder graph paper changed (if applicable) Electrical connections appear tight (or corrected if possible) Automatic Transfer Switch (if equipped):

Transfer switch normal power light is illuminated Isolating switch for standby power is closed

Building owner indicates that engine generator sets supplying emergency or standby power to fire pump assemblies shall be tested routinely in accordance with NFPA 110, Standard for Emergency and Standby Power Systems.

Fire Pump appears free from physical damage Oil level in vertical motor sight glass is normal Fire Pump shaft end play within specified tolerances Fire Pump coupling alignment within specified tolerances Parallel and angular alignment of fire pump and driver checked Jockey Pump:

Power is provided to jockey pump

Hangers: (Fire Pump or Pump Room Only) Y N/A N

Piping & Fittings: (Fire Pump and Pump Room Only) Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion

Valves:

PIVs and OS&Ys backed 1/4 turn from full open Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale

Pressure switches for fire pump and jockey pump set correctly Electrical system boxes, panels, and cabinets clean For Fire Pump Controllers with Circuit Breakers and/or Fuses Circuit breakers or fuses checked and exercised Electrical system circuit breakers or fuses changed within last two years?

Date of when circuit breakers and/or fuses were changed

Automatic Transfer Switch (if equipped):

The following test shall be performed to ensure that the overcurrent protective devices (i.e., fuses or circuit breakers) do not open:

Successfully simulate a power failure condition while the pump is operating at peak load

Verify that the transfer switch transfers power to the alternate power source

Verify that the pump continues to perform at peak horsepower load on the alternate power source for 10 minutes for an alternate utility or 30 minutes if the alternate power source is a standby generator set

Successfully remove the power failure condition and verify that, after a time delay, the pump is reconnected to the normal power source

Automatic transfer switches shall be tested routinely and exercised in accordance with

NFPA 110.

Isolating switch for standby power exercised

Pump bearing lubricated

Mechanical moving parts lubrication verified (excluding starters and relays)

Electric drive motor bearings lubricated

Fire pump assembly maintenance performed in accordance with mfg. recommendations (NA if this information is not provided by the owner)

Manual starting means of electrically driven pumps operated

II. Annual Fire Pump Performance Tests:

Electric Fire Pump and all equipment appear to be in service prior to the annual test Jockey Pump turned off for test Care taken to prevent water damage by verifying adequate drainage When testing with a Flowmeter and not flowing water outside, indicate the date of last test where water was flowed through the test header. (Test with flow through test header required every 3 years)

Fire Pump Churn Test:

Electric Pump starts when performing pressure drop test Pump starting pressure psi psi Time controller on first step (for reduced voltage or reduced current starting) sec Suction pressure gauge reading (while pump is running) psi Discharge pressure gauge reading (while pump is running) psi Packing gland discharging water (approx. 1 drip per second) if No, were packing glands adjusted (N/A if no adjustment was required)

No overheating of packing box, bearings or pump casing observed No abnormal noises/vibrations observed Circulation relief valve operational Pressure relief valve operational (if applicable) At churn, circulation relief valve checked for operation and water discharge At churn, pressure relief valve checked for proper operation At churn, pressure control valve checked for proper operation Alarms activated correctly For Fire Pump Flow Test using Flowmeter Flow meter adjusted immediately prior to testing in accordance with mfg. inst.

Test results using flow meter are consistent with previous annual test results (if “no” – complete flow test using hose streams OR calibrate flow meter)

Electric Fire Pump Annual Flow Test Annual Fire Pump Flow Test conducted per NFPA 25 Type of device(s) used to determine flows Flow test conducted under minimum, rated, and peak fire pump flows At each flow condition, simultaneous readings of pump suction and discharge pressures and pump discharge flow recorded (see appropriate section in Section III)

At each flow condition, electric motor voltage and current in all lines recorded (see appropriate section on in Section III)

III. Test Data:

Pressure & Flow

Suction

Discharge

Net Pump

Pump Speed

(RPM)

Pitot

Dia. of Nozzle

Openings No. of

Nozzles Flowed

Based on Pitot Pres.

Actual

(GPM)

Voltage & Current

Flow Volts Amps Lead #1 Lead #2 Lead #3 Lead #1 Lead #2 Lead #3

Remarks on Test

Date of the Test Time of Test

Person Conducting the Test Company

Witness Title

IV. Annual Fire Pump Test Completion:

Fire Pump Controller returned to the "Auto" setting

Jockey pump returned to service and operates satisfactory

FIRE PUMP LEFT IN SERVICE - DATE TIME

V. Annual Test Results and Evaluation:

(This section to be completed by after evaluating test results)

Pump results charted on N1.85 graph paper

Pump results compared to data from previous year

Fire pump operated at maximum allowable discharge (where available suction supplies do not allow flowing of 150 percent of rated pump capacity)

Fire pump suction supply provided required flow at 0 psi or higher gauge pressure at pump suction flange (except installations where NFPA 20 permitted negative suction gauge pressures)

Electric fire pump driver did not overload beyond rating (including service factor allowance) while delivering necessary brake horsepower

Theoretical rated speed correction factors not applied to determine pump compliance per testing

Engine speed not required to be increased beyond pump speed rating to achieve rated pump performance

Investigation initiated where degradation in excess of 5 percent of initial acceptance test pressure or nameplate pressure

Voltage readings at motor within 5 percent below or 10 percent above rated voltage

Abnormalities observed during inspection, testing, and maintenance promptly reported to responsible party

Annual Fire Pump Flow test matches initial unadjusted field acceptance test curve

Annual Fire Pump Flow matches performance characteristics on nameplate

Fire pump assembly considered acceptable

MNS Supplementary Record of Inspection and Testing

MASS NOTIFICATION SYSTEM

SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

This form is a supplement to the Fire Alarm Inspection & Test Report.

It includes a mass notification system test record.

This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test.

Insert N/A in all unused lines.

FACID Building

Mass Notification System Assessment Green Yellow Red

Fire Alarm system appears to operate as designed—Color Code (Color code is based on the following criteria: Green = No deficiencies or only noncritical

Comments/Deficiencies

Mass Notification System Information (if MNS is combination, enter “Combination” under Manufacturer)

Control Unit Manufacturer: Model Number: Location: Software Revision:

Primary Power

Voltage: Amps: Overcurrent Protection Type: Amps: Disconnecting Means Location:

Battery 1 Voltage: Amps: Mfr Year: Load Test

VDC: Ah: Temp (F):

Result of Battery 1 & 2

Battery 2

Pass Fail Replaced

Secondary

Other Power Present Description Yes No

MNS Power Supplies (for combination MNS panels where all tests are previously conducted, enter N/A for the tests below)

Type Visual Functional N/A Results

120-volt Power Pass Fail N/A

Generator or UPS

Battery Condition

Load Voltage

Discharge Test

Charger Test

Mass Notification System Type In-building MNS— combination

In-building MNS— stand alone

Wide Area

MNS

Indicate the MNS System Type

Mass Notification Equipment Tests

Functional Test

Reset/Power Down test

Fuses

Primary Power Supply

UPS Power Test

Trouble Signals

Disconnect Switches

Ground Fault Monitoring

CCU Security Mechanism

Prerecorded Message Content

Prerecorded Message Activation

Software Backup Performed

Test Backup Software

Fire Alarm to MNS Interface

MNS to Fire Alarm Interface

Sound Pressure Levels Ambient dBA ______ Alarm DBA ______

System Intelligibility Test Method ______ Score ______ CIS Value ______

Emergency Light Annual Inspection

Results:

Number of emergency lights inspected Number of emergency lights that failed inspection

Annual Emergency Light Inspection

Individual Battery-Powered Lighting Units: Activate not less than 90 minutes Central Battery Powered Lighting Systems: Activate not less than 90 minutes Emergency Generator-Powered Lighting Systems: During regularly scheduled generator and transfer switch maintenance, visually check operation of each emergency generator-powered fixture.

# Location Type Battery Type

Pass/Fail

Annual Emergency Light Inspection

# Location Type Battery Type

Pass/Fail

Fire Alarm Record of Inspection and Testing

Fire Alarm Annual Inspection & Testing Report

ONE REPORT SHALL BE COMPLETED FOR EACH BUILDING

Fire ProtecƟon Systems

Comments/Deficiencies

Fire Alarm System Assessment Green Yellow Red

Fire Alarm system appears to operate as designed—Color Code (Color code is based on the following criteria: Green = No deficiencies or only noncritical deficiencies; Yellow = System operates but has critical deficiencies; Red = System is inoperable

Fire Alarm Information

Control Unit Manufacturer: Model Number: Location: Software Revision:

SLCs/IDCs Max #: # Utilized: Style/Class: NAC

Circuits Max #: # Utilized: Style/Class:

Primary

Voltage: Amps: Overcurrent Protection Type: Amps: Disconnecting Means Location:

Result of Battery 1 & 2

Voltage: Amps: Mfr Year: VDC: Ah: Temp (F):

Pass Fail Replaced

Secondary

Other Power Present Description

Load Test

Mass Notification System Y N/A N

Building has a Mass Notification System (if yes, complete the Mass Notification Supplementary Record of Inspection and Testing)

Notifications are made Yes No Who Time

Monitoring Entity

Building Occupants

Building Management

AHJ Notified of Impairments

Notifications Prior Made to Any Testing

Alarm Initiating & Notification Device Count *See Notification & Initiating Appliances Supplementary Record of Inspection and Testing for Specific Results Circuit

Style Quantity of Devices

Tested

Manual Pull Station

Ion Smoke Detectors

Photo Smoke Detector

Duct Detectors

Heat Detectors

Carbon Monoxide Detectors

Waterflow Switches

Supervisory Switches Notification Devices (audio, visual, combo, etc)

Alarm Verification Feature is:

Type Visual Functional Results

Control Unit Pass Fail N/A

Lamps/LEDs/LCDs

Fuses

Trouble Signals

Ground-Fault Monitoring

Ground-Fault Monitoring

System Tests And Inspections

Supervision

Local Annunciator

Remote Annunciators

Power Extender Panels

Isolation modules

Other (specify)

N/A

Control Unit Power Supplies

120-volt Power Pass Fail N/A

Generator or UPS

Battery Condition

Load Voltage

Discharge Test

Charger Test

Supervising Station Monitoring

Alarm Signal Pass Fail N/A

Alarm Restoration

Trouble Signal

Trouble Restoration

Supervisory Signal

Supervisory Restoration

Time (sec)

Auxiliary Functions Type Visual Functional Comments

Door-releasing devices

Fan Shutdown Smoke Management/ Smoke Control

Smoke Damper Operation

Smoke Sutter Release

Door Unlocking

Elevator Recall

Elevator Shunt Trip

MNS Override of FA Sig-nals

Other (Specify)

N/A

Monitored Systems Type Visual Functional N/A Comments

Engine-driven Generator

Fire Pump

Kitchen Hood System

Dry Chemical System(s)

Notifications That Testing Is Complete

Notifications are made Yes No Who Time

Monitoring Entity Building Management

Inspector's Information I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments.

Inspected By Inspector License:

Signature of Inspector Date

Initiating and Supervisory Device Tests and Inspections Zone Device

Type Address Location Notes Last Tested Test Results Comments

NOTIFCATION & INTIATING APPLIANCE

SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

This form is a supplement to the Fire Alarm Inspection & Test Report.

It includes a notification appliance test record.

This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test.

Insert N/A in all unused lines.

FACID Building

CoD - Carbon Monoxide Detector DD - Duct Detector HORN - Horns/Horn-Strobes

LA - Low Air MM - Monitor Module (Ansul, temp, CO, etc) PS - Pull Station SD - Smoke Detector

SPKR - Speakers Strobe - Strobes TS - Tamper Switch WF - Waterflow Switch

HD - Heat Detector

Initiating and Supervisory Device Tests and Inspections (cont.)

Initiating and Supervisory Device Tests and Inspections (cont.)

Comments

Inspector's Information I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments.

Inspected By: Inspector License:

Signature of Inspector: Date:

Number of Devices Tested

Number of Devices the Failed

Results

Portable Fire Extinguisher Annual Inspection

Results

Evaluation & Notes:

Fire extinguishers are in designated locations Fire extinguishers are accessible and free of obstructions to visibility Pressure gauge reading or indicator checked for all extinguishers Fullness determined by weighing or hefting all extinguishers Condition of tires, wheels, carriage, hose, and nozzle for wheeled extinguishers

Number of fire extinguishers inspected Number of fire extinguishers requiring recharge only Number of fire extinguishers requiring hydro test and recharge Number of fire extinguishers requiring 6 yr. maintenance

Annual Fire Extinguisher Inspection

I = Annual Inspection, H = Hydro Test & Recharge, R = Recharge only, M = 6 yr. Maintenance Extinguisher Model/Type/Size

MFR

Date

Serial

Location

Service Performed

Next Hydro Due

Next 6 Year

Notes

Annual Fire Extinguisher Inspection

I = Annual Inspection, H = Hydro Test & Recharge, R = Recharge only, M = 6 yr. Maintenance

Model/Type/Size

MFR

Serial

Service Performed

Next Hydro

Next 6 Year

Notes

Fire Department Connections

Report of Annual Inspection

ONE REPORT SHALL BE COMPLETED FOR EACH FDC

FDC Physical Location

FDC is visible

FDC is accessible

FDC swivels/couplings undamaged/rotate smoothly

FDC plugs/caps in place/undamaged

FDC gaskets in place and in good condition

FDC identification sign in place

FDC check valve not leaking

FDC automatic drain valve in place and operating properly

FDC clapper is in place and operating properly

FDC interior inspected where caps missing

Wet Pipe Fire Sprinkler Systems

Manufacturer of sprinkler valve Size of sprinkler valve Model of sprinkler valve Year of Manufacture

IV. Annual Wet Fire Sprinkler System NFPA 25 Inspection Summary:

Wet fire sprinkler system considered acceptable based on inspection and performance tests

Annual NFPA 25 Wet Fire Sprinkler System Inspection

Does the wet pipe fire sprinkler system contain an auxiliary dry, preaction, or antifreeze system downstream of the wet control valves?

If yes, what type(s):

Addendum added to this inspection report for auxiliary system Date of last 5 year inspection Date of last Obstruction Inspection System Riser:

This system is clearly marked indicating the area served Hydraulic information sign provided at riser and is legible Wet system trim valves are in appropriate open or closed position System valves and equipment free of physical damage System valves, equipment, and drains not leaking Alarm device free from physical damage Spare sprinklers are of proper number (at least 6), type and temperature rating Spare sprinklers stored where temperature maximum is 100°F Wrench available for each type of sprinkler installed in this system Valves:

Control valve(s) completely open Control valves accessible Control valves properly locked or supervised Control valve identification signs in place Control valves are leak-free Gauges:

Gauges appear to be in good condition Supply pressure gauge psi System pressure gauge psi Gauge readings appear normal General System Observations (All observations taken from the floor. NFPA 25 does not require the inspector to enter any concealed spaces or leave the floor for these activities.)

Sprinklers:

Sprinklers appear free of leakage Sprinklers appear free of corrosion Sprinklers appear free of foreign materials Sprinklers appear free of paint Sprinklers appear free of physical damage Sprinklers appear properly oriented Sprinkler spray patterns appear free of obstructions Glass bulbs in applicable fire sprinklers appear full of liquid Piping & Fittings: (visible from the floor only) Piping appears free of mechanical damage Piping appears free of leakage Piping appears free of corrosion

Annual NFPA 25 Wet Fire Sprinkler System Inspection

Hangers: (visible from the floor only)

Environment:

All portions of the wet system are heated to at least 40°F

PIVs and OS&Ys backed 1/4 turn from full open

System Valve:

Alarm valve and check valves interiors thoroughly cleaned and inspected Gauges:

System gauges test/replacement date:

System gauges tested by comparison with calibrated gauge System gauges accurate within 3% of full scale

System Tests:

Inspector's Test conducted

Select the method below used for the Inspector’s Test

Wet system restored and left in service Date Time

Using remote inspectors test connection

Kitchen Hood System Annual Inspection

System Manufacturer Date Installed

Type of extinguishing agent

Equipment Protected:

(check all that apply)

IV. Annual Kitchen Hood System Inspection Summary:

Kitchen Hood System considered acceptable based on inspection and performance tests Form is attached listing the deficiencies and corrections needed

Potassium carbonate Potassium acetate

Combination potassium carbonate/potassium acetate

Deep fat fryer(s) Upright broiler(s)

Griddle(s) Grill(s) Range Top Other

Kitchen Hood System Inspection

Wet chemical cylinder Normal pressure: psi Manufacturer’s minimum pressure: psi Normal weight: lbs Manufacturer’s minimum weight: lbs

Connected to fire alarm system?

Automatic shutdown of cooking equipment?

If yes, is it Gas or Electric?

Nozzle caps are in place.

System components have no obvious physical damage.

Nozzles aim at cooking surfaces they protect.

Manual actuators are not obstructed.

Tamper indicators and seals are intact.

Maintenance tag or certificate is in place.

Pressure gauges are in operable range.

Expellant Gas Cartridge (if applicable) Pressure of nitrogen: psi Weight of carbon dioxide: lbs Fusible Link(s) (if applicable) Number of Fusible Links Temperature of Fusible Link(s) Deg F

Actuating Test:

Actuating test conducted Actuating test results satisfactory Cooking equipment shutdown satisfactory Fire Alarm activated Grease Fan continues to activate Fusible Link Replaced Hydrostatic Testing:

Date of Last Hydrostatic Test Last Hydrostatic Test (or installed) within 12 years

Wet system restored and left in service Date Time

Main Drain Test

Report of Annual Testing

ONE REPORT SHALL BE COMPLETED FOR EACH RUN-IN TO THE BUILDING

Main Drain Test Location

Size of Test Pipe

Test Results:

Static Pressure before test psi Residual Pressure during full flow psi Static Pressure after test psi Time for supply pressure to return to normal sec

Evaluation:

Current Test Results Compared to previous results

Comparison between the results is satisfactory

This form covers the minimum requirements of NFPA 25-2011 for water storage tanks. Separate forms are available for inspection, testing, and maintenance of other portions of the fire protection system of which the water tank is a part. More frequent inspection, testing, and maintenance may be necessary depending on the conditions of the occupancy and the water supply.

Notes:

All questions are to be answered Yes, No, or Not Applicable. All "No" answers are to be explained in the Comments for this form.

1.

Inspection, Testing and Maintenance are to be performed with water supplies (including fire pumps) in service, unless the impairment procedures of Chapter 15 of NFPA 25 are followed.

2.

The work covered on this form is (select one):

Date of Work All responses refer to the current work (inspection, testing and maintenance) performed on this date.

Owner:

Owner's Phone Number:

Owner's Address:

Property Being Evaluated:

Property Address:

Tanks(s):

Part I - Owner's Section A. Is the water storage tank in service? Yes No B. Remained in service since the last inspection? Yes No

C. Systems supplied by the tank free of actuation of devices or alarms since the last inspection?

Owner or Representative

Date Part II - Inspector's Section A. Inspections

1. Daily items during cold weather (tank is subject to freezing) In tank with no low temperature alarm:

a. Heating system is operational? Yes No N/A

b. Enclosure of automatic tank fill valve is okay? Yes No N/A

2. Weekly Items during cold weather (in addition to above items)

a. In tank with low temperature alarm, heating system is operational? Yes No N/A

b. If no low temperature alarm, record water temperature (°F):

c. Is above temperature acceptable? Yes No N/A

d. In tank with low temperature alarm, enclosure of automatic tank fill valve okay? Yes No N/A

3. Weekly Items Year Round (in addition to above items)

a. Control valves supervised with seals passed inspection items listed below in Part II.4.h?

Yes No N/A

b. Automatic tank fill valves (not locked or supervised) are open? Yes No N/A

4. Monthly Items (in addition to above items)

a. In tanks with no water level alarm, water level and condition are correct? Yes No N/A

b. In pressure tanks with no supervision, air pressure is correct? Yes No N/A

c. If low temperature alarm, record water temperature (°F):

d. Is above temperature acceptable? Yes No N/A

e. In tanks with locked or supervised automatic tank fill valves, are automatic fill valves open?

f. Exterior of automatic fill valve is okay? Yes No N/A

g. Gages: good condition, normal pressure? Yes No N/A

h. Control valves with locks or electrical supervision:

1. In correct open or closed position? Yes No N/A

2. Lock or supervision in place? Yes No N/A

3. Accessible and free from external leaks? Yes No N/A

4. Provided with appropriate wrenches? Yes No N/A

5. Provided with appropriate identification? Yes No N/A

5. Quarterly Items (in addition to above items)

a. In tanks with water level alarms, water level and condition are correct? Yes No N/A

b. In pressure tanks with pressure source supervised, is air pressure correct? Yes No N/A

c. Tank vents clean? Yes No N/A

d. Exterior of tank, support structure, foundation, condition of water in tank, catwalks and ladders, strong and free from obvious damage and ice?

e. Area around tank free from combustibles and materials that could accelerate corrosion and ice?

f. Strainers, filters and orifices of automatic tank fill valves are clean? Yes No N/A

g. Embankment-Supported Coated-Fabric tanks free from erosion along exterior sides? Yes No N/A

6. Annual Items (in addition to previous items)

a. Interior of automatic tank refill valves that cannot be reset externally okay? Yes No N/A

b. Exterior coated and insulated surfaces…