INSPECTION AND TESTING FORM DATE TIME SERVICE ORGANIZATION PROPERTY NAME USER Name Address Representative Owner Contact License No. Telephone MONITORING ENTITY APPROVING AGENCY Contact Monitoring Account Ref. No. TYPE TRANSMISSION SERVICE t McCulloh Multiplex Digital Reverse Priority RF Other Specify Control Unit Manufacturer Weekly Monthly Quarterly Semiannually Annually 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 Manual Fire Alarm Boxes Ion Detectors Photo Detectors Duct Detectors Heat Detectors Waterflow Switches Supervisory Switches NFPA Inspection and Testing 1 of 4 ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Bells Horns Chimes Strobes Speakers No. of alarm notification appliance circuits Are circuits monitored for integrity t Yes t No SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION Building Temp. Site Water Temp. Site Water Level Fire Pump Power Fire Pump Running Fire Pump Auto Position Fire Pump or Pump Controller Trouble Generator In Auto Position Generator or Controller Trouble Switch Transfer Generator Engine Running Other SIGNALING LINE CIRCUITS Quantity and style See NFPA 72 Table 3-6 of signaling line circuits connected to system Style s SYSTEM POWER SUPPLIES a. Primary Main Nominal Voltage Overcurrent Protection Type Location of Primary Supply Panelboard Disconnecting Means Location b. Secondary Standby Amps Storage Battery Amp-Hr. Rating Calculated capacity to operate system in hours Engine-driven generator dedicated to fire alarm system Location of fuel storage TYPE BATTERY c* Dry Cell Nickel-Cadmium Sealed Lead-Acid Lead-Acid Emergency 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 requirements of Article 700 or 701. PRIOR TO ANY TESTING No NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management AHJ Notified of Any Impairments Who Time SYSTEM TESTS AND INSPECTIONS Visible Functional TYPE Interface Eq. Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring Comments SECONDARY POWER Battery Condition Load Voltage Discharge Test Charger Test Specific Gravity TRANSIENT SUPPRESSORS REMOTE ANNUNCIATORS Audible Visual Voice Clarity INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS Device Type Check Test Loc* S/N Factory Setting Meas. Pass Fail Operation Simulated EMERGENCY COMMUNICATIONS EQUIPMENT Phone Set Phone Jacks Off-Hook Indicator Amplifier s Tone Generator s Call-in Signal System Performance INTERFACE EQUIPMENT Specify SPECIAL HAZARD SYSTEMS Special Procedures SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Supervisory Restoration Monitoring Agency The following did not operate correctly System restored to normal operation Date THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS* Name of Inspector Date Signature Name of Owner or Representative.
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