fire sprinkler systems general information sheet · 2016. 11. 8. · inspection and test of wet...
TRANSCRIPT
Date
State
Zip Code
Cell #
Y N NA
Y N NA
Owners Name (Print)
Inspectors Name (Print)
Has the alarm monitoring company been notified of return to normal operation?
Are there any troubles or alarms that will not clear from FACP?
Is there backflow protection?
Have all systems been returned to full service and sealed?
Pre
Action
Does the sprinkler system show signs of modification since last inspection?
Name of monitoring company
Does the FDC have proper identification?
Does the FDC automatic drain valve operating correctly?(ball drip)
Do the FDC couplings and swivels operate correctly?
ALL NO ANSWERS ARE A DEFICIENCY PER NFPA 25- 2011
FIRE DEPARTMENT CONNECTION INSPECTION
Is there a fire pump?
Is the FDC visible and accessible?
Are all unprotected areas per NFPA 13? ( see system report)
Are all gaskets in place and in good condition?
Are the FDC caps/plugs in place? If no, obstruction check must be performed
Was the alarm system impaired before inspection was performed?
Does the system have a monitored alarm system?
Has the fire department been notified before performing inspection?
Is there an anti-freeze system present?
Has the monitoring company been notified? To be by owner per nfpa 25 5.1.3
Location of Fire Department
Connection (FDC)
Number of systems
Building Information Report (Answer all questions with Y,N, or NA)
Address
City
Phone Number
WetType of Sprinkler Systems in
BuildingDry
Contact Name
Customer Name
INSPECTION AND TEST OF AUTOMATIC SPRINKLER SYSTEMS
Are the FDC clappers present and in working order?
Is the FDC check valve leak free?
Did the monitoring company receive all alarms?
FoamStand
PipeDomestic
Was the sprinkler system impaired before inspection was performed?
Is building fully protected by sprinklers?
All defiencies indicated on Page 2 of system report
Signature
Signature
Name or ID# of monitoring operator
State Cert. #AS0046 / Electrical Cert. #52-01415 / Mechanical Cert. #71-07058 / Hydrostatic Cert. #C427
AS PER STATE AND LOCAL REGULATIONS A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTORS OFFICE
BFP Style BFP Size
FIRE SPRINKLER SYSTEMS GENERAL INFORMATION SHEET
FIRE PROS INC. Sales | Service | Inspections | Installations
1-800-968-2871 “For All of Your Fire Protection & Security Needs”
2710 Northridge Dr., Ste #FGrand Rapids, MI 49544
5815 Churchman Ave., Ste #3Indianapolis, IN 46203
www.firepros.com
2710 NORTHRIDGE DR. NW, SUITE F, GRAND RAPIDS MI, 49534 Phone (616) 453-4800 · Fax (616) 453-5883 · Toll Free 1-800-968-2871
Static Residual
Minutes Seconds
Y N NA
10. Are all gauges free of damage?
11. Was the system water flow alarm tested thru the ITV? Bypass in cold condition
12. Is the ITV properly orificed?
13. Is the ITV properly identified?
26. Are all pipe and fittings free of leaks or damage?
27. Are all relief valves maintaining system @ or below 175 psi?
28. Are all valves free of leaks and damage?
18. Are standard sprinklers less than 50 years old?
19. Are all dry pendents less than 10 years old?
20. Are all quick response sprinklers less than 20 years old?
21. Is there a spare head box at the riser?
22. Are proper clearance distance from sprinkler being maintained?
23. Is the correct type and number of spare sprinklers available?
4. Is the control valve properly identified?
5 Does the tamper alarm operate correctly if present?
6. Was a main drain test performed after operation of control valve?
24. Is there a head wrench for each type sprinkler available?
25. Are all hangers and bracing in good condition? (not damaged or loose)
14. Did the water flow alarm operate with in allowable time? (90 sec. per NFPA 72)
15. Did the outside alarm operate properly?
16. Have all sprinklers been installed in the proper orientation?
17. Are all sprinklers free of damage? (leaks, paint, corrosion, foreign material)
8. Is the main drain valve properly identified?
ALL NO ANSWERS ARE A DEFICIENCY PER NFPA 25
Main drain test results
7. Was main drain test recorded and results within 10% of last report?(see last tag)
9. After main drain test all control valves left open and sealed?
1. Is the fire protection riser accessible?
Wet system Inspection Report (Answer all questions with Y,N, or NA
Time to alarm thru ITV
2. Have all control valves been operated thru full range of operation?
3. Does the control valve have supervision? (locked or tamper switch)
Size of riser Identification number of Wet Riser
Location of riser
Location of ITV
ANNUAL WET SYSTEM INSPECTION
www.firepros.com
INSPECTION AND TEST OF WET SPRINKLER SYSTEMS
per NFPA 25This report covers
All testing and inspecting of water based sprinkler systems
PAGE 1
Customers Name
Customers Address
State Cert. #AS0046 / Electrical Cert. #52-01415 / Mechanical Cert. #71-07058 / Hydrostatic Cert. #C427
AS PER STATE AND LOCAL REGULATIONS A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTORS OFFICE
Quantity of Gauges
Date of Gauge(s)
Date Standard Response
Date Dry Pendents
Date Quick Response
Other Information (if applicable)
Y N NA
Yes Yes Yes
Yes Yes Yes
Y N NA
Date of inspection
NOTE "GENERAL INFO" IF DEFICIENCY IS FROM THE GENERAL INFORMATION PAGE
comments
Inspectors Name
The areas listed below have been found to not meet NFPA 13 code and require review
LIST BELOW DEFICIENCIES AND LINE ITEM NUMBER THAT REFERS TO SAME
INSPECTION AND TEST OF WET SPRINKLER SYSTEMS (CONTINUED)
Required PSI Required GPM Hose demand
Date:
LIST ALL AREAS THAT DO NOT MEET NFPA 13 (overhead doors,added offices,etc)
ALL NO ANSWERS ARE A DEFICIENCY PER NFPA 25
ITEMS BELOW REQUIRE MAINTENANCE EVERY 5 YEARS PER NFPA 25
33. Have all gauges been tested or replaced if over 5 years old?
34. Have all check valves been internally inspected every 5 years?
35. Has a internal pipe investigation been performed within 5 years?
36. Have all alarm valves been internally inspected within 5 years?
37. Have all pressure reducing valves been tested and flowed every 5 years?
38. What is the date of last 5 year inspection?
Hydraulic information Residential EH-I(storage) EH-II (storage)
Hydraulic information Light(office) OH-I(retail) OH-II(storage)
29.Is this system been hydraulically designed?
30. If yes, is there a legible hydraulic placard attached to the riser?
31. Is this system pipe scheduled design?
32. Is the building use per original design? Original design to be provided by owner
Customers Name
Customers Address
INSPECTION AND TEST OF WET SPRINKLER SYSTEMS (CONTINUED)
If the system has been hydraulically designed a legible placard must be attached
PAGE 2
State Cert. #AS0046 / Electrical Cert. #52-01415 / Mechanical Cert. #71-07058 / Hydrostatic Cert. #C427
AS PER STATE AND LOCAL REGULATIONS A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTORS OFFICE
2710 NORTHRIDGE DR. NW, SUITE F, GRAND RAPIDS MI, 49534 Phone (616) 453-4800 · Fax (616) 453-5883 · Toll Free 1-800-968-2871
COMPANY NAME:
ADDRESS:
CITY/STATE:
DATE: BY:
ITEM ZONE TYPE MODEL LOCATION PASS FAIL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
MP - Manual Pull S- Strobe DM - Magnetic Door Closer
FIRE PROS INC.
Alarm Device Report
LEGEND
SD - Smoke Detector DD-Duct Detector HS - horn Strobe HD - Heat Detector
www.firepros.com
State Certification #ASOO46 / Elec. Certification 52-01415 / Mech. Certification #71-07058 / Hydrostatic Certification #C427
AS PER STATE AND LOCAL REGULATIONS, A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTORS OFFICE
FIRE PROS INC. CUST
2710 NORTHRIDGE DR STE F Toll Free 1-800-968-2871 Fax (616) 453-5883
GRAND RAPIDS MI 49544 Phone (616) 453-4800 www.firepros.com
Company: Date:
Address: Last Insp:
City, State, Zip Insp By:
Entity Name: YES NO
Monitor Notified
Account Reference #: Alarm Put In Test
Acknowledge Trouble
Phone Number: Acknowledge Alarm
Monitoring Back In Service
Charging Circuit Output: Volts Make:
Battery Voltage: Volts Model:
Battery Size:
Date Due for Replacement:
Location of Breaker Panel:
Addressable: YES NO
# of Initiating Zones # of Indicating Circuits Devices
YES NO N/A
YES NO
Reason not authorized:
DEFICIENCIES
RECOMMENDATIONS / NOTES
Fire Pros Inspector
Devices
Customer's printed name:
System left in service?
The alarm system functions as installed?
Noted violations have been corrected or have been authorized for repair?
Customer's signature:
PANEL
Lamps, LED’s, Fuses
Power Loss
Secondary Power Loss (Does Panel Recognize Low or Loss of Battery)
Zone Trouble
Signal Trouble
Disconnect Switches
Interfaced Equipment (Door Magnets, Annunciators)
FIRE ALARM INSPECTION AND TESTING REPORT
MONITORING
State Certification #ASOO46 / Elec. Certification 52-01415 / Mech. Certification #71-07058
A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTOR'S OFFICE
COMPANY NAME:
BY:
NU
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QU
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FA
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SIZE PA
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UN
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CITY/STATE:
ADDRESS:
NOTES: (BREAKER LOCATION, DEFICIENCIES, ETC.)
BATTERY
DATE:
BULBCHARGING
BOARD TEST
State Certification #ASOO46 / Elec. Certification 52-01415 / Mech. Certification #71-07058 / Hydrostatic Certification #C427
AS PER STATE AND LOCAL REGULATIONS, A COPY OF THIS REPORT WILL BE SENT TO THE FIRE INSPECTORS OFFICE
Revised 3/07
FIRE PROS INC. Sales | Service | Inspections | Installations
1-800-968-2871 “For All of Your Fire Protection & Security Needs”
2710 Northridge Dr., Ste #FGrand Rapids, MI 49544
5815 Churchman Ave., Ste #3Indianapolis, IN 46203
www.firepros.com
EMERGENCY / EXIT LIGHTS INSPECTION REPORT
LOCATIONUNIT TYPE
FE # Size Agent MFG DateNext Maint.
Due (Year)
Next Maint.
TypeService PerformedUnit Location Inspected Le
ft
Loan
er
State Certification #ASOO46 / Elec. Certification 52-01415 / Mech. Certification #71-07058 / Hydrostatic Certification #C427
(Year)
OtherG - Gauge S - SignB - Bracket M - Mount
v1.01-2016
Extinguisher Identification Extinguisher Information Inspection & Work Performed
PORTABLE FIRE EXTINGUISHER INSPECTION REPORT
Customer:
Address:
City:
Technician #2: Technician #1:
Date:
State: Zip:
1-800-968-2871www.firepros.com
FIRE PROS INC.2710 Northridge Dr., Ste #FGrand Rapids, MI 49544
5815 Churchman Ave,, Ste #3Indianapolis, IN 46203
“For All of Your Fire Protection & Security Needs”
Sales | Service | Inspections | Installations
Manufacturer
(Day) (Year)(Month)
Inspection Frequency
Annual
Semi-Annual
Monthly
Quarterly