Fire alarm and Emergency communication system inspection and testing form




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FIRE ALARM and Emergency communication system inspection and testing form

To be completed by the system inspector or tester at the time of the inspection or test.

It shall be permitted to modify this form as needed to provide a more complete and/or clear record.

Insert N/A in all unused lines.

Attach additional sheets, data, or calculations as necessary to provide a complete record.


Date of this inspection or test:

     

Time of inspection or test:

     

1. Property Information

Name of property:

     

Address:

     

Description of property:

     

Occupancy type:

     

Name of property representative:

     

Address:

     

Phone:

     

Fax:

     

E-mail:

     

Authority having jurisdiction over this property:

     

Phone:

     

Fax:

     

E-mail:

     

2. Installation, Service, and Testing contractor Information

Service and/or testing organization for this equipment:

     

Address:

     

Phone:

     

Fax:

     

E-mail:

     

Service technician or tester:

     

Qualifications of technician or tester:

     

A contract for test and inspection in accordance with NFPA standards is in effect as of:

     

The contract expires:

     

Contract number:

     

Frequency of tests and inspections:

     

Monitoring organization for this equipment:

     

Address:

     

Phone:

     

Fax:

     

E-mail:

     

Entity to which alarms are retransmitted:

     

Phone:

     

3. Type of System or Service

 Fire alarm system (nonvoice)

 Fire alarm with in-building fire emergency voice alarm communication system (EVACS)

 Mass notification system (MNS)

 Combination system, with the following components:

 Fire alarm  EVACS  MNS  Two-way, in-building, emergency communication system



 Other (specify):

     

3. Type of System or Service (continued)

NFPA 72 edition:

     

Additional description of system(s):

     

3.1 Control Unit

Manufacturer:

     

Model number:

     

3.2 Mass Notification System  This system does not incorporate an MNS.

3.2.1 System Type:

 In-building MNS—combination

 In-building MNS—stand-alone  Wide-area MNS  Distributed recipient MNS

 Other (specify):

     

3.2.2 System Features:

 Combination fire alarm/MNS  MNS ACU only  Wide-area MNS to regional national alerting interface

 Local operating console (LOC)  Direct recipient MNS (DRMNS)  Wide-area MNS to DRMNS interface

 Wide-area MNS to high-power speaker array (HPSA) interface  In-building MNS to wide-area MNS interface



 Other (specify):

     

3.3 System Documentation

 An owner’s manual, a copy of the manufacturer’s instructions, a written sequence of operation, and a copy of the record



record drawings are stored on site.

Location:

     

3.4 System Software  This system does not have alterable site-specific software.

Software revision number:

     

Software last updated on:

     

 A copy of the site-specific software is stored on site. Location:

     

4. System power

4.1 Control Unit

4.1.1 Primary Power

Input voltage of control panel:

     

Control panel amps:

     

4.1.2 Engine-Driven Generator  This system does not have a generator.

Location of generator:

     

Location of fuel storage:

     

Type of fuel:

     

4.1.3 Uninterruptible Power System  This system does not have a UPS.

Equipment powered by a UPS system:

     

Location of UPS system:

     

Calculated capacity of UPS batteries to drive the system components connected to it:

In standby mode (hours):

     

In alarm mode (minutes):

     

4. System power (continued)

4.1.4 Batteries

Location:

     

Type:

     

Nominal voltage:

     

Amp/hour rating:

     

Calculated capacity of batteries to drive the system:

In standby mode (hours):

     

In alarm mode (minutes):

     

 Batteries are marked with date of manufacture.

4.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System

 This system does not have an EVACS or MNS.

4.2.1 Primary Power

Input voltage of EVACS or MNS panel:

     

EVACS or MNS panel amps:

     

4.2.2 Engine-Driven Generator  This system does not have a generator.

Location of generator:

     

Location of fuel storage:

     

Type of fuel:

     

4.2.3 Uninterruptible Power System  This system does not have a UPS.

Equipment powered by a UPS system:

     

Location of UPS system:

     

Calculated capacity of UPS batteries to drive the system components connected to it:

In standby mode (hours):

     

In alarm mode (minutes):

     

4.2.4 Batteries

Location:

     

Type:

     

Nominal voltage:

     

Amp/hour rating:

     

Calculated capacity of batteries to drive the system:

In standby mode (hours):

     

In alarm mode (minutes):

     

 Batteries are marked with date of manufacture.

4.3 Notification Appliance Power Extender Panels  This system does not have power extender panels.

4.3.1 Primary Power

Input voltage of power extender panel(s):

     

Power extender panel amps:

     

4.3.2 Engine-Driven Generator  This system does not have a generator.

Location of generator:

     

Location of fuel storage:

     

Type of fuel:

     

4.3.3 Uninterruptible Power System  This system does not have a UPS.

Equipment powered by a UPS system:

     

Location of UPS system:

     

Calculated capacity of UPS batteries to drive the system components connected to it:

In standby mode (hours):

     

In alarm mode (minutes):

     


4. System power (continued)

4.3.4 Batteries

Location:

     

Type:

     

Nominal voltage:

     

Amp/hour rating:

     

Calculated capacity of batteries to drive the system:

In standby mode (hours):

     

In alarm mode (minutes):

     

 Batteries are marked with date of manufacture.

5. Annunciators  This system does not have annunciators.

5.1 Location and Description of Annunciators

Annunciator 1:

     

Annunciator 2:

     

Annunciator 3:

     

6. Notifications made prior to testing

Monitoring organization

Contact:

     

Time:

     

Building management

Contact:

     

Time:

     

Building occupants

Contact:

     

Time:

     

Authority having jurisdiction

Contact:

     

Time:

     

Other, if required

Contact:

     

Time:

     

7. Testing results

7.1 Control Unit and Related Equipment

Description

Visual Inspection

Functional Test

Comments

Control unit





     

Lamps/LEDs/LCDs





     

Fuses





     

Trouble signals





     

Disconnect switches





     

Ground-fault monitoring





     

Supervision





     

Local annunciator





     

Remote annunciators





     

Power extender panels





     

Isolation modules





     

Other (specify)

     





     

7. Testing results (continued)

7.2 Control Unit Power Supplies

Description

Visual Inspection

Functional Test

Comments

120-volt power





     

Generator or UPS





     

Battery condition





     

Load voltage





     

Discharge test





     

Charger test





     

Other (specify)

     





     

7.3 In-Building Fire Emergency Voice Alarm Communications Equipment

Description

Visual Inspection

Functional Test

Comments

Control unit





     

Lamps/LEDs/LCDs





     

Fuses





     

Primary power supply





     

Secondary power supply





     

Trouble signals





     

Disconnect switches





     

Ground-fault monitoring





     

Panel supervision





     

System performance





     

Sound pressure levels

Occupied  Yes  No







     

Ambient

     

dBA

Alarm

     

dBA

(attach report with locations, values, and weather conditions)

System intelligibility

 CSI  STI



(attach report with locations, values, and weather conditions)





     

Other (specify)

     





     

7. Testing results (continued)

7.4 Notification Appliance Power Extender Panels

Description

Visual Inspection

Functional Test

Comments

Lamps/LEDs/LCDs





     

Fuses





     

Primary power supply





     

Secondary power supply





     

Trouble signals





     

Ground-fault monitoring





     

Panel supervision





     

Other (specify)

     





     

7.5 Mass Notification Equipment

Description

Visual Inspection

Functional Test

Comments

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





     

In-building MNS to wide-area MNS





     


7. Testing results (continued)

7.5 Mass Notification Equipment (continued)

Description

Visual Inspection

Functional Test

Comments

MNS to direct recipient MNS





     

Sound pressure levels

Occupied  Yes  No







     

Ambient

     

dBA

Alarm

     

dBA

(attach report with locations, values, and weather conditions)

System intelligibility

 CSI  STI



(attach report with locations, values, and weather conditions)





     

Other (specify)

     





     

7.6 Two-Way Communications Equipment

Description

Visual Inspection

Functional Test

Comments

Phone handsets





     

Phone jacks





     

Off-hook indicator





     

Call-in signal





     

System performance





     

System audibility





     

System intelligibility





     

Radio communications enhancement system





     

Area of refuge communication system





     

Elevator emergency communications system





     

Other (specify)

     





     


7. Testing results (continued)

7.7 Combination Systems

Description

Visual Inspection

Functional Test

Comments

Fire extinguishing monitoring devices/system





     

Carbon monoxide detector/system





     

Combination fire/security system





     

Other (specify)

     





     

7.8 Special Hazard Systems

Description (specify)

Visual Inspection

Functional Test

Comments

     





     

     





     

     





     

7.9 Emergency Communications System

 Visual


 Functional

 Simulated operation

 Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS.

See NFPA 72, 24.4.1.7.1.



7.10 Monitored Systems

Description (specify)

Visual Inspection

Functional Test

Comments

Engine-driven generator





     

Fire pump





     

Special suppression systems





     

Other (specify)

     





     

7. Testing results (continued)

7.11 Auxiliary Functions

Description

Visual Inspection

Functional Test

Comments

Door-releasing devices





     

Fan shutdown





     

Smoke management/smoke control





     

Smoke damper operation





     

Smoke shutter release





     

Door unlocking





     

Elevator recall





     

Elevator shunt trip





     

MNS override of FA signals





     

Other (specify)

     





     

7.12 Alarm Initiating Device

 Device test results sheet attached listing all devices tested and the results of the testing



7.13 Supervisory Alarm Initiating Device

 Device test results sheet attached listing all devices tested and the results of the testing



7.14 Alarm Notification Appliances

 Appliance test results sheet attached listing all appliances tested and the results of the testing



7.15 Supervisory Station Monitoring

Description

Yes

No

Time

Comments

Alarm signal





     

     

Alarm restoration





     

     

Trouble signal





     

     

Trouble restoration





     

     

Supervisory signal





     

     

Supervisory restoration





     

     


8. Notifications that testing is complete

Monitoring organization

Contact:

     

Time:

     

Building management

Contact:

     

Time:

     

Building occupants

Contact:

     

Time:

     

Authority having jurisdiction

Contact:

     

Time:

     

Other, if required

Contact:

     

Time:

     

9. system restored to normal operation

Date:

     

Time:

     

10. Certification

10.1 Inspector Certification:

This system, as specified herein, has been inspected and tested according to all NFPA standards cited herein.



Signed:

     

Printed name:

     

Date:

     

Organization:

     

Title:

     

Phone:

     

10.2 Acceptance by Owner or Owner’s Representative:

The undersigned has a service contract for this system in effect as of the date shown below.



Signed:

     

Printed name:

     

Date:

     

Organization:

     

Title:

     

Phone:

     


Device test results

(Attach additional sheets if required)


Device Type

Address

Location

Test Results

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     




NFPA 72, Fig. 14.6.2.4 (p. of )
Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.


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