INSPECTION AND TESTING FORM - NFPA

1 DATE:TIME:SERVICE ORGANIZATIONPROPERTY NAME (USER)Name:Name:Address:Address:Represen tative:Owner Contact:License No.:Telephone:Telephone:MONITORING ENTITYAPPROVING AGENCYC ontact:Contact:Telephone:Telephone:Monit oring Account Ref. No.:TYPE TRANSMISSIONSERVICEoMcCullohoWeeklyoMult iplexoMonthlyoDigitaloQuarterlyoReverse PriorityoSemiannuallyoRFoAnnuallyoOther (Specify)oOther (Specify)Control Unit Manufacturer:Model No.:Circuit Styles:Number of Circuits:Software Rev.:Last Date System Had Any Service Performed:Last Date that Any Software or Configuration Was Revised:ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity Circuit StyleManual Fire Alarm BoxesIon DetectorsPhoto DetectorsDuct DetectorsHeat DetectorsWaterflow SwitchesSupervisory SwitchesOther (Specify): INSPECTION AND TESTING FORM( nfpa INSPECTION and TESTING 1 of 4)ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity Circuit StyleBellsHornsChimesStrobesSpeakersOthe r (Specify):No.

2 Of alarm notification appliance circuits:Are circuits monitored for integrity? o Yes o NoSUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity Circuit StyleBuilding Water Water LevelFire Pump PowerFire Pump RunningFire Pump Auto PositionFire Pump or Pump controller TroubleFire Pump RunningGenerator In Auto PositionGenerator or controller TroubleSwitch TransferGenerator engine RunningOther:SIGNALING LINE CIRCUITSQ uantity and style (See nfpa 72, Table 3-6) of signaling line circuits connected to system:QuantityStyle(s)SYSTEM POWER (Main): Nominal Voltage , AmpsOvercurrent Protection: Type , AmpsLocation (of Primary Supply Panelboard):Disconnecting Means (Standby):Storage Battery: Amp-Hr. RatingCalculated capacity to operate system, in hours: 24 60 engine -driven generator dedicated to fire alarm system:Location of fuel storage:TYPE BATTERYoDry CelloNickel-CadmiumoSealed Lead-AcidoLead-AcidoOther (Specify) or standby system used as a backup to primary power supply, instead of using a secondary power supply:Emergency system described in nfpa 70, Article 700 Legally required standby described in nfpa 70, Article 701 Optional standby system described in nfpa 70, Article 702, which also meets the performance requirementsof Article 700 or 701.

3 ( nfpa INSPECTION and TESTING 2 of 4)PRIOR TO ANY TESTINGNOTIFICATIONS ARE MADEYesNoWhoTimeMonitoring Entity Building Occupants Building Management Other (Specify) AHJ (Notified) of Any Impairments SYSTEM TESTS AND INSPECTIONSTYPEV isibleFunctionalCommentsControl Unit Interface Eq. Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring SECONDARY POWERTYPE Visible FunctionalCommentsBattery Condition Load Voltage Discharge Test Charger Test Specific Gravity TRANSIENT SUPPRESSORS REMOTE ANNUNCIATORS NOTIFICATION APPLIANCESA udible Visual Speakers Voice Clarity INITIATING AND SUPERVISORY DEVICE TESTS AND & S/NTypeCheckTestSettingSettingPassFail Comments:( nfpa INSPECTION and TESTING 3 of 4)EMERGENCY COMMUNICATIONS EQUIPMENTV isualFunctionalCommentsPhone Set ooPhone Jacks ooOff-Hook Indicator ooAmplifier(s) ooTone Generator(s) ooCall-in Signal ooSystem Performance ooDeviceSimulatedVisualOperationOperatio nINTERFACE EQUIPMENT (Specify) ooo (Specify) ooo (Specify) oooSPECIAL HAZARD SYSTEMS (Specify) ooo (Specify) ooo (Specify) oooSpecial Procedures:Comments.

4 SUPERVISING STATION MONITORINGYesNoTimeCommentsAlarm Signal o oAlarm Restoration o oTrouble Signal o oSupervisory Signal o oSupervisory Restoration o oNOTIFICATIONS THAT TESTING IS COMPLETEYesNoWhoTimeBuilding Management o oMonitoring Agency o oBuilding Occupants o oOther (Specify) o oThe following did not operate correctly:System restored to normal operation: Date: Time:THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE nfpa of Inspector: Date: Time:Signature:Name of Owner or Representative:Date:Time:Signature:( nfpa INSPECTION and TESTING 4 of 4)