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:
1. PROPERTY INFORMATION

Time of inspection or test:

Name of property: Address:

Description of property: Occupancy type:

Name of property representative: Address: Phone:

Fax:

E-mail:

Authority having urisdiction over this property: Phone:

Fax:

E-mail:

2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION

!ervice and"or testing organi#ation for this e$uipment: Address: Phone:

Fax:

E-mail:

!ervice technician or tester:

%ualifications of technician or tester:

A contract for test and inspection in accordance &ith NFPA standards is in effect as of: The contract expires:

'ontract num(er:

Fre$uency of tests and inspections:

)onitoring organi#ation for this e$uipment: Address: Phone:

Fax:

E-mail:

Entity to &hich alarms are retransmitted:

Phone:

3. TYPE OF SYSTEM OR SERVICE

Fire alarm system *nonvoice+ Fire alarm &ith in-(uilding fire emergency voice alarm communication system *E,A'!+ )ass notification system *)N!+ 'om(ination system- &ith the follo&ing components: Fire alarm
Other *specify+:

E,A'!

)N!

T&o-&ay- in-(uilding- emergency communication system

NFPA 72, Fig. 14.6.2.4 (p. 1 of 11)

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3. TYPE OF SYSTEM OR SERVICE (continued)

NFPA 72 edition: 3.1 Control Unit )anufacturer:

Additional description of system*s+:

)odel num(er: !hi

3.2 Ma Noti!i"ation S# t$% an (N). 3.2.1 System Type: .n-(uilding )N!/com(ination .n-(uilding )N!/stand-alone Other *specify+:

y te" $oe not incorporate

0ide-area )N!

Distri(uted recipient )N!

3.2.2 S# t$% F$at&r$ ' 'om(ination fire alarm")N! 2ocal operating console *2O'+

)N! A'1 only

0ide-area )N! to regional national alerting interface 0ide-area )N! to D3)N! interface

Direct recipient )N! *D3)N!+

0ide-area )N! to high-po&er spea4er array *5P!A+ interface Other *specify+:

.n-(uilding )N! to &ide-area )N! interface

3.3 S# t$% Do"&%$ntation An o&ner6s manual- a copy of the manufacturer6s instructions- a &ritten se$uence of operation- and a copy of the record record dra&ings are stored on site7 2ocation: 3.( S# t$% So!t)ar$ oft+are. !oft&are revision num(er:

!hi

y te" $oe not ha%e altera#le ite* pecific

!oft&are last updated on:

A copy of the site-specific soft&are is stored on site7 2ocation:

(. SYSTEM PO*ER

4.1 Control Unit 4.1.1 Primary Power .nput voltage of control panel:

'ontrol panel amps:

(.1.2 En+in$,Dri-$n G$n$rator generator. 2ocation of generator: 2ocation of fuel storage:

!hi

y te" $oe not ha%e a

Type of fuel:

(.1.3 Unint$rr&.ti/l$ Po)$r S# t$% ,P). E$uipment po&ered (y a 1P! system: 2ocation of 1P! system:

!hi

y te" $oe not ha%e a

Calc&late$ capacity of ,P) #atterie to $ri%e the y te" co"ponent connecte$ to it-

.n stand(y mode *hours+:

.n alarm mode *minutes+:

NFPA 72, Fig. 14.6.2.4 (p. 2 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

(. SYSTEM PO*ER (continued)

4.1.4 Batteries 2ocation:

Type:

Nominal voltage:

Amp"hour rating:

'alculated capacity of (atteries to drive the system: .n stand(y mode *hours+:

.n alarm mode *minutes+:

8atteries are mar4ed &ith date of manufacture7 4.2 In-Building ire !mergen"y #oi"e $larm Communi"ation System or %ass &oti'i"ation System This system does not have an E,A'! or )N!7 4.2.1 Primary Power .nput voltage of E,A'! or )N! panel:
(.2.2 En+in$,Dri-$n G$n$rator

E,A'! or )N! panel amps:

!hi

y te" $oe not ha%e a generator.

2ocation of generator: 2ocation of fuel storage:

Type of fuel:

(.2.3 Unint$rr&.ti/l$ Po)$r S# t$%

!hi

y te" $oe not ha%e a ,P).

E$uipment po&ered (y a 1P! system: 2ocation of 1P! system:

Calc&late$ capacity of ,P) #atterie to $ri%e the y te" co"ponent connecte$ to it-

.n stand(y mode *hours+:

(.2.( 0att$ri$

.n alarm mode *minutes+:

2ocation:

Type:

Nominal voltage:

Amp"hour rating:

'alculated capacity of (atteries to drive the system: .n stand(y mode *hours+:

.n alarm mode *minutes+:

8atteries are mar4ed &ith date of manufacture7 4.3 &oti'i"ation $pplian"e Power !(tender Panels 4.3.1 Primary Power .nput voltage of po&er extender panel*s+:
(.3.2 En+in$,Dri-$n G$n$rator

This system does not have po&er extender panels7

Po&er extender panel amps:

!hi

y te" $oe not ha%e a generator.

2ocation of generator: 2ocation of fuel storage:

Type of fuel:

(.3.3 Unint$rr&.ti/l$ Po)$r S# t$%

!hi

y te" $oe not ha%e a ,P).

E$uipment po&ered (y a 1P! system: 2ocation of 1P! system:

Calc&late$ capacity of ,P) #atterie to $ri%e the y te" co"ponent connecte$ to it-

.n stand(y mode *hours+:

.n alarm mode *minutes+:

NFPA 72, Fig. 14.6.2.4 (p. . of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

(. SYSTEM PO*ER (continued)

4.3.4 Batteries 2ocation:

Type:

Nominal voltage:

Amp"hour rating:

'alculated capacity of (atteries to drive the system: .n stand(y mode *hours+:

.n alarm mode *minutes+:

8atteries are mar4ed &ith date of manufacture7

1. ANNUNCIATORS
).1 *o"ation and +es"ription o' $nnun"iators Annunciator 9: Annunciator :: Annunciator ;:

This system does not have annunciators7

2. NOTIFICATIONS MADE PRIOR TO TESTING

)onitoring organi#ation 8uilding management 8uilding occupants Authority having urisdiction Other- if re$uired 'ontact: 'ontact: 'ontact: 'ontact: 'ontact:

Time: Time: Time: Time: Time:

3. TESTING RESULTS
,.1 Control Unit and -elated !.uipment #isual Inspe"tion un"tional Test

+es"ription 'ontrol unit 2amps"2EDs"2'Ds Fuses Trou(le signals Disconnect s&itches <round-fault monitoring !upervision 2ocal annunciator 3emote annunciators Po&er extender panels .solation modules Other *specify+

Comments

NFPA 72, Fig. 14.6.2.4 (p. 4 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

3. TESTING RESULTS (continued)

,.2 Control Unit Power Supplies #isual Inspe"tion un"tional Test

+es"ription 9:=-volt po&er <enerator or 1P! 8attery condition 2oad voltage Discharge test 'harger test Other *specify+

Comments

3.3 In,0&il4in+ Fir$ E%$r+$n"# Voi"$ Alar% Co%%&ni"ation E5&i.%$nt #isual Inspe"tion un"tional Test

+es"ription 'ontrol unit 2amps"2EDs"2'Ds Fuses Primary po&er supply !econdary po&er supply Trou(le signals Disconnect s&itches <round-fault monitoring Panel supervision !ystem performance !ound pressure levels Occupied Am(ient Alarm >es

Comments

No d8A d8A

*attach report &ith locations- valuesand &eather conditions+

!ystem intelligi(ility '!. !T.

*attach report &ith locations- valuesand &eather conditions+

Other *specify+

NFPA 72, Fig. 14.6.2.4 (p. / of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

3. TESTING RESULTS (continued)

,.4 &oti'i"ation $pplian"e Power !(tender Panels #isual Inspe"tion un"tional Test

+es"ription 2amps"2EDs"2'Ds Fuses Primary po&er supply !econdary po&er supply Trou(le signals <round-fault monitoring Panel supervision Other *specify+ 3.1 Ma

Comments

Noti!i"ation E5&i.%$nt #isual Inspe"tion un"tional Test

+es"ription Functional test 3eset"po&er do&n test Fuses Primary po&er supply 1P! po&er test Trou(le signals Disconnect s&itches <round-fault monitoring ''1 security mechanism Prerecorded message content Prerecorded message activation !oft&are (ac4up performed Test (ac4up soft&are Fire alarm to )N! interface )N! to fire alarm interface .n-(uilding )N! to &ide-area )N!

Comments

NFPA 72, Fig. 14.6.2.4 (p. 6 of 11)

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3. TESTING RESULTS (continued)

,.) %ass &oti'i"ation !.uipment (continued) #isual Inspe"tion un"tional Test

+es"ription )N! to direct recipient )N! !ound pressure levels Occupied Am(ient Alarm >es

Comments

No d8A d8A

*attach report &ith locations- valuesand &eather conditions+

!ystem intelligi(ility '!. !T.

*attach report &ith locations- valuesand &eather conditions+

Other *specify+

,./ Two-0ay Communi"ations !.uipment #isual Inspe"tion un"tional Test

+es"ription Phone handsets Phone ac4s Off-hoo4 indicator 'all-in signal !ystem performance !ystem audi(ility !ystem intelligi(ility 3adio communications enhancement system Area of refuge communication system Elevator emergency communications system Other *specify+

Comments

NFPA 72, Fig. 14.6.2.4 (p. 0 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

3. TESTING RESULTS (continued)

,., Com1ination Systems #isual Inspe"tion un"tional Test

+es"ription Fire extinguishing monitoring devices"system 'ar(on monoxide detector"system 'om(ination fire"security system Other *specify+

Comments

,.2 Spe"ial 3a4ard Systems #isual Inspe"tion un"tional Test

+es"ription 5spe"i'y6

Comments

,.7 !mergen"y Communi"ations System ,isual Functional !imulated operation Ensure predischarge notification appliances of special ha#ard systems are not overridden (y the )N!7 !ee NFPA 72- :?7?797@797 ,.18 %onitored Systems #isual Inspe"tion un"tional Test

+es"ription 5spe"i'y6 Engine-driven generator Fire pump !pecial suppression systems Other *specify+

Comments

NFPA 72, Fig. 14.6.2.4 (p. 1 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

3. TESTING RESULTS (continued)

,.11 $u(iliary un"tions #isual Inspe"tion un"tional Test

+es"ription Door-releasing devices Fan shutdo&n !mo4e management"smo4e control !mo4e damper operation !mo4e shutter release Door unloc4ing Elevator recall Elevator shunt trip )N! override of FA signals Other *specify+

Comments

,.12 $larm Initiating +e9i"e Device test results sheet attached listing all devices tested and the results of the testing ,.13 Super9isory $larm Initiating +e9i"e Device test results sheet attached listing all devices tested and the results of the testing ,.14 $larm &oti'i"ation $pplian"es Appliance test results sheet attached listing all appliances tested and the results of the testing ,.1) Super9isory Station %onitoring +es"ription Alarm signal Alarm restoration Trou(le signal Trou(le restoration !upervisory signal !upervisory restoration :es &o Time

Comments

NFPA 72, Fig. 14.6.2.4 (p. 9 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.

6. NOTIFICATIONS T7AT TESTING IS COMPLETE

)onitoring organi#ation 8uilding management 8uilding occupants Authority having urisdiction Other- if re$uired 'ontact: 'ontact: 'ontact: 'ontact: 'ontact:

Time: Time: Time: Time: Time:

8. SYSTEM RESTORED TO NORMAL OPERATION

Date:

Time:

19. CERTIFICATION
18.1 Inspe"tor Certi'i"ation: This system- as specified herein- has (een inspected and tested according to all NFPA standards cited herein7 !igned:

Printed name: Title:

Date: Phone:

Organi#ation:

18.2 $""eptan"e 1y ;wner or ;wner<s -epresentati9e: The undersigned has a service contract for this system in effect as of the date sho&n (elo&7 !igned:

Printed name: Title:

Date: Phone:

Organi#ation:

NFPA 72, Fig. 14.6.2.4 (p. 10 of 11)

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DEVICE TEST RESULTS

5$tta"= additional s=eets i' re.uired6

+e9i"e Type

$ddress

*o"ation

Test -esults

NFPA 72, Fig. 14.6.2.4 (p. 11 of 11)

Copyright 2009 National Fire Protection A ociation. !hi for" "ay #e copie$ for in$i%i$&al & e other than for re ale. 't "ay not #e copie$ for co""ercial ale or $i tri#&tion.