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FA REPORT - 17-00801 - 2300 University Blvd - Madison High School - Addition
FIRE ALARM INSPECTION & TESTING REPORT SYSTEM TYPE: FIRE ALARM FM-200 ECARO-25 HALON INERGEN CO2 DRY CHEMICAL (Check all applicable) PRE-ACTION OTHER: INSPECTION TYPE: ANNUAL SEMI-ANNUAL QUARTERLY OTHER CUSTOMER NAME: ADDRESS: PROTECTED AREAS: CONTACT NAME: MONITORED BY: PANEL MFG: MODEL: PRE-TEST CHECK LIST TASK VERIFICATION STATUS CENTRAL STATION / FIRE DEPT. NOTIFIED YES NO N/A BUILDING / AREA OCCUPANTS NOTIFIED YES NO N/A BUILDING ALARM / TROUBLE DISABLED YES NO N/A HVAC / DAMPERS DISABLED YES NO N/A POWER SHUTDOWN / EPO DISABLED YES NO N/A RELEASING DEVICES DISCONNECTED YES NO N/A OTHER: YES NO N/A ALARM INITIATING DEVICES DEVICE QUANTITY TESTED DEVICE QUANTITY TESTED MANUAL STATIONS WATERFLOW SMOKE DETECTORS TAMPER DUCT DETECTORS LOW AIR HEAT DETECTORS LINEAR HEAT CABLE ABORT SWITCHES RELEASING METHOD ( Check if N/A) CROSS ZONE DETECTION MANUAL RELEASE: INSTANT DELAY ZONE VERIFICATION ABORT OVERRIDE: TIME DELAY ( ) SINGLE DETECTOR GCA / SQUIBB DATE: SOLENOID RELEASE OTHER: ALARM INDICATING DEVICES DEVICE QTY. TESTED SYNCHRONIZED (SPECIFY) BELLS HORN / STROBES HORNS STROBES ___ SPEAKERS SPEAKER / STROBES CHIMES Technician #: __ Date: Job/W.O. #: Page _____ of _____ CUSTOMER / AREA: SYSTEM TESTS BATTERIES (NW = Not Working NT = Not Tested NA = Not Applicable) SERIAL # PRESS LEVEL/ WEIGHT HYDRO DATE SERIAL # PRESS LEVEL/ WEIGHT HYDRO DATE AGENT CONTAINER DATE ( Check if N/A) POST-TEST CHECK LIST TASK STATUS TASK STATUS BUILDING ALARM / TROUBLE ENABLED YES NO N/A ALARM SIGNALS RECEIVED (NT ) YES NO N/A HVAC / DAMPERS ENABLED YES NO N/A TROUBLE SIGNALS RECEIVED (NT ) YES NO N/A POWER SHUTDOWN / EPO ENABLED YES NO N/A BUILDING / AREA OCCUPANTS NOTIFIED YES NO N/A RELEASING DEVICES RECONNECTED YES NO N/A CENTRAL STATION / FIRE DEPT. NOTIFIED YES NO N/A APPLICABLE NFPA STANDARDS NFPA 12 (CARBON DIOXIDE) NFPA 17 (DRY CHEM. EXT. SYSTEMS) NFPA 2001 (CLEAN AGENT) NFPA 12A (HALON 1301) NFPA 72 (NATIONAL FIRE ALARM) OTHER ( ) NFPA 13 (SPRINKLER SYSTEMS) NFPA 101 (LIFE SAFETY) COMMENTS/RECOMMENDATONS: Customer’s Authorized Agent Signature Print Name Date Technician/Inspector Signature Date LOCATION BATTERY 1 VOLTAGE / AMPS BATTERY 2 VOLTAGE / AMPS AH OK NW NT NA CONTROL PANEL PANEL LAMPS / LEDS _ REMOTE ANNUNCIATORS POWER SUPPLY PANEL(S) DOOR HOLDERS ELEVATOR RECALL HVAC / DAMPERS BYPASS / DISCONNECT SWITCHES _ RELEASE CIRCUITS POWER SHUTDOWN / EPO _ ROOM / AREA INTEGRITY BATTERIES ( _) Page _____ of _____