2018 Mallard Road, Unit #1

London, Ontario N6H 5L8

Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 9th, 2016

Building Name: Wallaceburg Board Office

Address: 420 Creek St. Wallaceburg

Security/Fire Alarm Panel [Make / Model]: Notifier AFP 200C

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:
All devices now in good working order, however, Vipond to change the location descriptions as the room #'s have been changed.
Once complete a letter from Vipond verifying this has been completed & tested should be forwarded and added to this file.

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ___________________________

CFAA #: 19-995199 CFAA #: _________________________

Signature: ___________________ Signature: ________________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Pass RC ADMIN Name DAMAR
System #: 883 344 Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: F2 Version:

Record the date, revision and version of the program software: √

Date: Revision: A Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance and above ceiling tile

Control unit or transponder identification Notifier

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance (Above Ceiling Tile)
Circuit breaker or disconnect means location Electrical Room 126

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number FACP- NP7-12T BPS- SLA12-7
Battery manufacturer's date code or ins service date Date 2013 2015
Battery Voltage (main power supply 'ON') is Voltage 27.71 24.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.39 N/A
in supervisory condition Current (A) 0.201 N/A
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.19 N/A
in full load condition Current (A) 0.274 N/A
The charging current is Current (mA) 809 N/A

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Reco AH 12 7
Record the battery terminal voltage after tests are completed. VDC 27.01 N/A

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): Main 4.97 Booster N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication
link (DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location Main Entrance
Control Unit or Transponder Identification Notifier
Data Communication link identification Addressable Loop

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble) √

Card Reader Lockout √

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Wallaceburg Board Office Address: 420 Creek Street, Wallaceburg Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Main Entrance E H/S √ √

Main Entrance W H/S √ √

Room 102 H/S √ √

Room 102 H/S √ √

Room 102 H/S √ √

Room 100 H/S √ √

Room 100 H/S √ √

By Room 132 H/S √ √ High

By Room 117 Copy Room H/S √ √

By Room 118 H/S √ √

By Room 113 H/S √ √

By 118 H/S √ √

By 112 H/S √ √

By 108 H/S √ √

By Room 226 H/S √ √ EOL

Cubicle Area W H/S √ √

By Room 218 H/S √ √

By Room 209 H/S √ √

By Room 210 H/S √ √

Cubicle Area E H/S √ √

By Room 204 H/S √ √

Mechanical Room 205A H/S √ √

Elevator Room 228 H/S √ √

By 218 EOL X See Repairs List

By 210 EOL X See Repairs List

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address SDX-511A 0.35-1.19 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Wallaceburg Board Office Address: 420 Creek Street, Wallaceburg Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

1st Floor West Exit M √ √ M02
1st Floor East Exit M √ √ M08
1st Floor Reception M √ √ M10
1st Floor South Exit M √ √ M21
2nd Floor North Stair M √ √ M31
2nd Floor South Stair M √ √ M49
Photocopy Room 111 RHT √ X √ D05 High ↓

Room 102 Kitchen RHT √ X √ D06

Room 103 Storage RHT √ X √ D07

Room 137 Coat Room RHT √ X √ D13

Room 135 Files Room N RHT √ X √ D14
Room 135 Files Room S RHT √ X √ D15
Room 136 East RHT √ X √ D16
Room 136 Southwest RHT √ X √ D17
See Comments
1st Supply Duct West DS √ X √ D18 on Repairs List
Room 136 Northwest RHT √ X √ D19
Room 128 N S √ X √ D20 1.02
Room 131 RHT √ X √ D23
Room 123 RHT √ X √ D24
Room 127 S √ X √ D25 1.03
1st Floor South Storage RHT √ X √ D26
North Stair S √ X √ D33 1.09
Elevator Shaft RHT X D34 See Repairs List

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address SDX-511A 0.35-1.19 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Wallaceburg Board Office Address: 420 Creek Street, Wallaceburg Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 201 East RHT √ X √ D35
Room 201 West RHT √ X √ D36
Room 206 RHT √ X √ D37
2nd Supply Duct Northeast DS √ √ D38

2nd Supply Duct Northwest DS √ √ D39

Plant Storage Room RHT √ X √ D40
Room 221 RHT √ X √ D41
1st Supply Duct East DS √ √ D42
Room 215 West RHT √ X √ D43
Room 215 East RHT √ X √ D44
Room 215 South RHT √ X √ D45
2nd Supply Duct SW DS √ √ D46
2nd Supply Duct SE DS √ √ D47
Room 217 RHT √ X √ D48
South Stair S √ X √ D51
By Fire Panel ISO Ok

By Fire Panel ISO Ok

By Fire Panel ISO Ok

Activation of this relay locks out
Double Doors to Cubicles Relay √ √ M12 access on FOB Reader

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address SDX-511A 0.35-1.19 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Wallaceburg Board Office Address: 420 Creek Street, Wallaceburg

LOCATION MODEL # BATTERY # A B C D REMARKS

2nd Floor
Top Of North Stair RG 36 PA-6V7.2 (08) 4 6.79 12:31 251 X See Repairs List
Exit From Stair RG 36 LER PA-6V7.2 (08) 2 7.12 12:35 253 X See Repairs List
By Elevator RG 36 LER PA-6V7.2 (09) 2 6.89 12:30 264 X See Repairs List
End Of Northwest Hall RG 36 LER PA-6V7.2 (12) 4 6.87 12:32 301
Southwest By Meeting Room RG 36 LER PA-6V7.2 (12) 2 7.01 12:33 269
By South Stair RG 36 LER PA-6V7.2 (13) 2 7.12 12:27 252
Top Of South Stair RG 36 PA-6V12 (12) 4 6.98 12:26 291
End Of South East Hall RG 36 LER PA-6V7.2 (09) 4 6.87 12:28 253 X See Repairs List
Northeast Hall RG 36 LER PA-6V7.2 (11) 4 7.01 12:29 291

1st Floor
Front Entrance RG 36 LER PA-6V7.2 (14) 2 7.10 12:16 276
Mail Room SLC12 250 PA-12V32 (15) 2 13.97 12:12 283
Board Room East RG 36 LER PA-6V7.2 (14) 2 6.89 12:14 294
Entrance to Parking Lot RG 36 LER PA-6V7.2 (09) 2 6.87 12:16 256 X See Repairs List
Centre Doors To Lobby RG 36 LER PA-6V7.2 (11) 4 7.01 12:17 293
By Coatroom RG 36 LER PA-6V7.2 (09) 2 6.87 12:18 286
Northwest Corner RG 36 LER PA-6V7.2 (08) 4 6.92 12:19 287 X See Repairs List
Southwest Corner RG 36 LER PA-6V7.2 (11) 2 6.84 12:20 254
By South Stair RG 36 LER PA-6V7.2 (10) 2 6.83 12:21 261
South Exit RG 36 LER PA-6V7.2 (12) 2 6.89 12:22 271 X See Repairs List
Back of Computer Room RG 36 PA-6V7.2 (12) 3 6.78 12:50 283
Southeast Corner Hall RG 36 LER PA-6V7.2 (12) 4 6.97 12:23 286
Northeast Corner Hall RG 36 LER PA-6V7.2 (11) 2 6.89 12:24 239 X See Repairs List

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Vipond to reprogram the device locations as the facility has changed their room #'s during construction.
To be completed. All devices have been tested and are in good working order.

Booster Power supply not supervised, upon arrival we found the BPS in trouble as the charger had failed .
Vipond has now corrected, checked by AEI October 12th, 2016.

Emergency Lighting
1 Top Of North Stair RG 36 Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
2 Exit From Stair RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
3 By Elevator RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
4 End Of South East Hall RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
5 Entrance to Parking Lot RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
6 Northwest Corner RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
7 South Exit RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016
8 Northeast Corner Hall RG 36 LER Replaced battery w/(1) Panasonic LCR067R2P 08/31/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 8th, 2016

Building Name: Christ the King

Address: 227 Thomas Ave, Wallaceburg

Security/Fire Alarm Panel [Make / Model]: Edwards EST 6604

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

Building is under construction (wire demolition), therefore we could only complete the inspection of emergency lighting.

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: _______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883325 Royal Hawks
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Room 120B

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP5-12
Battery manufacturer's date code or ins service date Date 2010
Battery Voltage (main power supply 'ON') is Voltage N/A
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage N/A
in supervisory condition Current (A) N/A
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage N/A
in full load condition Current (A) N/A
The charging current is Current (mA) N/A
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH N/A
Record the battery terminal voltage after tests are completed. VDC N/A

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location
Annunciator or remote trouble signal unit identification

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations
Annunciator or sequential display identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm & Trouble) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Christ the King Address: 227 Thomas Street, Wallaceburg Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Stage HT 4 High

NE Gym Ceiling HT 4 High

NW Gym Ceiling HT 4 High

SE Gym Ceiling HT 4 High

SW Gym Ceiling HT 4 High

Gym SE Exit M 4
Gym H S-1
Boy's Change Room RHT 4
Girl's Change Room RHT 4
Gym Storage- 1 RHT 4 High

Gym Storage- 2 RHT 4 High

NW Exit M 4
Under Stage HT Under Construction 4
Hall By Gym S (C2M PDI) 4
Exit By Gym M 4
Kitchen By Gym RHT 4
West Exit To Gym M 1 EOL
Hall @ 108 B S-1
Hall West By Room 108 S (C2M PDI) 1
Room 108 RHT (281C) 4
Room 108 M 4
Room 108 B S-1
Hall Centre By Room 106 S (C2M PDI) 1
Room 106 RHT (281C) 4
Room 106 B S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Christ the King Address: 227 Thomas Street, Wallaceburg Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Principal Room (100-A) RHT 1
Secretary Office (100) RHT 1
Front Entrance M 1

Room 104 S (C2M-PDI) 1

Room 102 RHT (281C) 1

Front Entrance S (C2M-PDI) 1

Storage By Front Door- (116) RHT 1
Library Entrance S (C2M-PDI) 3
Library Entrance M 3
Study Room # 118 RHT 3
Library Storage RHT 3
Library Front RHT 3
Library B Under Construction S-1
Library Electrical (120B) RHT 3 EOL

Library Back RHT 3 High

Library Exit M 3
Hall By Library B S-1
Staff Room # 122 RHT 1
Slop Sink Room # 124 HT 1
Hall by Room # 109 S (C2M-PDI) 1
Furnace HT 1
Hall By Furnace M 1
Furnace Room M 1
Furnace Room Storage HT 2
100 A B S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Christ the King Address: 227 Thomas Street, Wallaceburg Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Room # 128 HT 2
Room # 115 HT 2
Room # 130 RHT 2
Room # 117 RHT 2
Hall By Locker 177 S (C2M-PDI) 2
Under Construction
Hall By Locker 177 B S-1
Locker 106 S (C2M-PDI) 2
Classroom Room 132 S (C2M-PDI) 2
North Exit M 2 EOL
North Storage Room 119 S (C2M-PDI) 2

At Hall To Gym DH
Under Construction
At Hall To Gym AUX Relay S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Christ the Address: 227 Thomas Street, Wallaceburg

LOCATION MODEL # BATTERY #RH A B C D REMARKS

Hall By 117 RG 36 PA-6V7.2 (14) 2 6.87 11:30 .380

Hall By Room 128 RG 36 PA-6V7.2 (12) 2 6.91 11:34 .398

Library RG 36 PA-6V7.2 (14) 2 7.01 11:36 .388

By 102 Enerwatt PA-6V12 (10) 2 N/A 11:37 .120 X See Repairs List
Room 108 NV12100 (2) C-Cell 6V12 (11) 6 13.71 11:40 1.141

Start of New Addition CDL 36 PA-6V7.2 (12) 2 6.93 11:43 .294

By 112 RG 12S 36 NP5-12 (10) 2 13.60 11:45 .463

Exit By 105 RG 36 LE 450 PA-6V7.2 (12) 2 6.91 11:47 .293

Gym Exit To Hall RG 36 LE 450 PA-6V12 (12) 2 6.92 11:50 .346

Women’s Change Room RG 12S 36 NP5-12 (10) 2 6.81 11:52 .360

Men’s Change Room RG 12S 36 NP5-12 (11) 2 6.89 11:53 .300

Gym SE Exit RG 36 LE 450 PA6V7.2 AH (09) 2 N/A 11:50 .800 X See Repairs List
Gym SW Wall RG 36 (2) PA-6V4.5 (10) 2 13.61 11:50 .390

Gym NW Exit RG 36 PA-6V7.2 (10) 2 6.79 11:50 .298

Gym- RightStage RG 36 PA6V7.2 AH (09) 2 N/A 11:50 .100 X See Repairs List
Gym- Left Stage RG 36 Lumacell 6V7 2 7.00 11:50 .270

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm
Under Construction- To Be Tested By Others

Emergency Lighting
1 By 102 Enerwatt Replaced Battery w/ (1) Panasonic PA-6V12 08/05/2016
2 Gym SE Exit RG 36 LE 450 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/05/2016
3 Gym- RightStage RG 36 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/05/2016

Additional Comments:
Please note that we were unable to test the fire alarm system due to the building being under construction (wire demolition
A verification of the work preformed by Vince Ferro Construction LTD. will be required.
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE EMERGENCY LIGHTING AT THE FOLLOWING LOCATION:

CHRIST THE KING, 227 THOMAS AVENUE, WALLACEBURG

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH CANADIAN ULC CODES AND DESIGN CRITERIA
DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-991599
FA. REP'S TECH: Kevin Bury DATED: August 8th, 2016
CFAA #: 19-991599
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

TECHNICIANS PRE-TEST CHECKLIST

Date: August 2nd, 2016

Address: Building Services Centre - 525 Baldoon Road, Chatham

Alert the management of the building that the fire alarm system is being tested and that alternate measures under the Fire
Safety Plan should be implemented.

Check that an alternative plan has been established to alert occupants and the local fire department should an actual fire
condition occur during testing.

Check the Technicians' responsibilities, if any, under that alternative measures of the Fire Safety Plan.

If there is a remote connection to a central station or fire department take necessary steps to alert central station or fire
department.

Do not use the Fire Department Emergency telephone number.

Contacted regarding testing: a.) Fire Dispatch X b.) Security X

Contact additional info: Damar Syst # 883343/ Pass RC Maintenance

WORK TO BE COMPLETED: a.) Annual Inspection of the Interconnected Smoke Alarms X

√ - YES X - NO N/A - NOT APPLICABLE

Tested Correctly Did Not Test Correctly Function or Feature Not Provided
(See Remarks) On This Fire Alarm System

N/A Are there ancillary functions that can impair building functions such as elevator capture, fan shutdown, door holders, etc.?
N/A Can these be disabled and tested by groups?
√ Have building occupants been made aware of fire alarm testing?
√ Has a pre-determined time been established for testing signalling devices?
√ Have provisions been made for acquiring access to the secured areas of the building?
√ Are there spare reset and panel keys available?

TECHNICIANS AFTER-TEST CHECKLIST

DEFICIENCIES FOUND DURING INSPECTION
N/A Reconnect Ancillary Function (off-site connections) YES NO N/A
√ Reconnect Ancillary Function Fire/Smoke Alarm √
N/A Reconnect Time Limit Cutouts Emergency Lighting √
√ Reconnect Signal Power Fire Extinguishers √
√ Advise Building Management Work Completed Sprinkler System √
√ Advise Fire Dept. and/or Security Co. Work has been Completed Other (Signage Etc.) √
√ Ensure the Alarm System is Functional All Deficiencies Repaired: August 31st, 2016

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature:__________________________ Signature:__________________________
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
SMOKE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: Maintenance Warehouse Address: 525 Baldoon Road, Chatham Page 1 of 1

LOCATION DEVICE A B C D E F SENS. REMARKS

Library North SA (12V) X See Repairs List
Library South SA (12V) X See Repairs List
East Bay By Lunchroom RHT √ √

Wash Bay RHT √ √

Tractor Bay RHT √ √

Wood Shop RHT √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: Maintenance Warehouse Address: 525 Baldoon Road, Chatham Page 1 of 1

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

1 Wood Shop (West End) 12 MSL360 PA-1233 (10) 2 13.41 1:00 Panel D cct #36

2 Metal Shop @ Mezzanine RG-36 PA-6V12 (14) 2 6.91 1:00 Panel A cct #24

3 Main Entrance HXSW-36 PA-6V7.2 (09) 2 6.81 1:00 Panel C #29

4 Main Entrance 12 MSL360 PA-1233 (08) 2 13.67 1:00 Brk #29 Panel C

5 Library Entrance RG-36 LMC PA-6V7.2 (12) 2 6.71 1:00

6 Library North Exit RG-36 LMC PA-6V7.2 (12) 2 6.21 1:00

Breaker 24 Panel "A"

Panel B Breaker #1

A- Battery Float Voltage (AC Power On)

B- Test Start Time
C- Battery Charge Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

SMOKE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Smoke Alarm Devices
1 Library North SA (12V) Replaced Device w/ (1) System Sensor 2012HA 08/31/2016
2 Library South SA (12V) Replaced Device w/ (1) System Sensor 2012HA 08/31/2016

Emergency Lighting Devices

Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE SMOKE ALARM SYSTEM AT THE FOLLOWING LOCATION;
BUILDING SERVICES~ 525 BALDOON ROAD, CHATHAM
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Kevin Bury DATED: August 31st, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

TECHNICIANS PRE-TEST CHECKLIST

Date: July 18th, 2016

Address: Building Services Centre - 245 Tecumseh St., Sarnia

Alert the management of the building that the fire alarm system is being tested and that alternate measures under the Fire
Safety Plan should be implemented.

Check that an alternative plan has been established to alert occupants and the local fire department should an actual fire
condition occur during testing.

Check the Technicians' responsibilities, if any, under that alternative measures of the Fire Safety Plan.

If there is a remote connection to a central station or fire department take necessary steps to alert central station or fire
department.

Do not use the Fire Department Emergency telephone number.

Contacted regarding testing: a.) Fire Dispatch X b.) Security N/A

Contact additional info:

WORK TO BE COMPLETED: a.) Annual Inspection of the Interconnected Smoke Alarms X

√ - YES X - NO N/A - NOT APPLICABLE

Tested Correctly Did Not Test Correctly Function or Feature Not Provided
(See Remarks) On This Fire Alarm System

N/A Are there ancillary functions that can impair building functions such as elevator capture, fan shutdown, door holders, etc.?
N/A Can these be disabled and tested by groups?
√ Have building occupants been made aware of fire alarm testing?
√ Has a pre-determined time been established for testing signalling devices?
√ Have provisions been made for acquiring access to the secured areas of the building?
N/A Are there spare reset and panel keys available?

TECHNICIANS AFTER-TEST CHECKLIST

DEFICIENCIES FOUND DURING INSPECTION
N/A Reconnect Ancillary Function (off-site connections) YES NO N/A
N/A Reconnect Ancillary Function Fire/Smoke Alarm √
N/A Reconnect Time Limit Cutouts Emergency Lighting √
√ Reconnect Signal Power Fire Extinguishers √
√ Advise Building Management Work Completed Sprinkler System √
√ Advise Fire Dept. and/or Security Co. Work has been Completed Other (Signage Etc.) √
√ Ensure the Alarm System is Functional All Deficiencies Repaired: July 19th, 2016

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-9952091 CFAA #: _____________________

Signature:__________________________ Signature:__________________________
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
SMOKE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 18th, 2016

Building Name: Building Services Address: 245 Tecumseh Street, Sarnia Page 1 of 1

DATE
LOCATION DEVICE A B C D E F CODE REMARKS
Office Area Cubicles SA (110V) √ √ 2010
Shop West Wall SA (110V) √ √ 2014
Open Area By Records SA (9V) X 2006 See Repairs List
Records Area SA (9V) X 2006 See Repairs List
Metal Shop SA (9V) X 2006 See Repairs List
Wood Shop SA (9V) X 2006 See Repairs List
Northeast Storage SA (9V) X 2006 See Repairs List

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 18th, 2016

Building Name: Building Services Address: 245 Tecumseh Street, Sarnia

LOCATION MODEL # BATTERY # A B C D REMARKS

Main Exit 6 PXM 36 PA-6V7.2 (12) 2 6.71 2:30 .450
Rear Exit (Shop) RG36 LMC PA-6V7.2 (14) 2 6.82 2:30 .500
Staff Room RG36 PE-6V7.2 (12) 2 6.91 2:30 .300
Wall by Staff Room RG36 PA-6V12 (13) 2 6.90 2:30 .431
Wall at Back of Offices RG36 PA-6V12 (09) 2 6.00 2:30 - X See Repairs List
Metal Shop Exit 6 PXM 36 PA-6V7.2 (13) 2 6.93 2:30 .450
Wood Shop RG36 PA-6V7.2 (09) 4 6.10 2:30 - X See Repairs List

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Testing Current
D- Repairs Completed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Open Area By Records SA (9V) Replaced Device w/ (1) Kidde 0916 Smoke Detector 07/18/2016
2 Records Area SA (9V) Replaced Device w/ (1) Kidde 0916 Smoke Detector 07/18/2016
3 Metal Shop SA (9V) Replaced Device w/ (1) Kidde 0916 Smoke Detector 07/18/2016
4 Wood Shop SA (9V) Replaced Device w/ (1) Kidde 0916 Smoke Detector 07/18/2016
5 Northeast Storage SA (9V) Replaced Device w/ (1) Kidde 0916 Smoke Detector 07/18/2016

Emergency Lighting
1 Wall at Back of Offices RG36 Replaced Battery w/ (1) Panasonic PA-6V7.2 07/18/2016
2 Wood Shop RG36 Replaced Battery w/ (1) Panasonic PA-6V7.2 07/18/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 18th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE SMOKE ALARM SYSTEM AT THE FOLLOWING LOCATION;
FACILITY SERVICES BUILDING~ 245 TECUMSEH ST, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: July 18th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 9th, 2016

Building Name: Gregory A. Hogan

Address: 1825 Hogan Drive, Sarnia

Security/Fire Alarm Panel [Make / Model]: Edwards Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs completed during inspection

I A copy of this report has been given to: SCCDSB- Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was
left in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for
examination by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ______________________

CFAA #: 19-996382 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR-114650 Gryphons
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Room # 137

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP12-12 (2) Enersys NP7.2-12
Battery manufacturer's date code or ins service date Date 2015 2015
Battery Voltage (main power supply 'ON') is Voltage 26.90 26.40
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.50 26.10
supervisory condition Current (A) 0.430 0.06
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.10 24.80
full load condition Current (A) 0.325 1.214
The charging current is Current (mA) 480 920

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation;

(ii) Silent test using load resistor method for full duration test.

(iii) Silent accelerated test.

(iv) A battery capacity meter test.

(v) Replace the batteries with a new set having a current date code/capacity/type
Record battery capacity AH
Record the battery terminal voltage after tests are completed. VDC

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): FACP / Booster
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication
link (DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 1825 Hogan Drive, Sarnia Building Name: Gregory A. Hogan Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit By 137 M √ √ 1
Room 137 M √ √ 1
Room 137 HT √ √ 1 Elec. Test

Room 137 HT √ √ 1 Elec. Test

By 137 S (C2M PDI) √ √ 1

By 137 H/S √ √ S-B
By 140 EOL √ √ S-A
By 138 S (C2M PDI) √ √ 1
By 135 H/S √ √ S-A EOL

By 135 S (C2M PDI) √ √ 1

Room 131 H √ √ S-B EOL

Room 129B S (C2M PDI) √ √ 1

Room 129B M √ √ 1
Room 129 H √ √ S-B
By 127 H/S √ √ 1
By 127 EOL √ √ 1
Room 127 H/S √ √ S-B
By 127 S (C2M PDI) √ √ 1
By 127 H/S √ √ S-B
By 136 S (C2M PDI) √ √ 1
Room 134 RHT √ √ 1
Room 134 RHT √ √ 1
By 132 H/S √ √ S-A
By 123 S (C2M PDI) √ √ 1
Room 123 H √ √ S-B
Room 121B S (C2M PDI) √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 1825 Hogan Drive, Sarnia Building Name: Gregory A. Hogan Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 121B M √ √ 1
Room 121B EOL √ √ 1
Room 121 H √ √ S-B
By 100 S (C2M PDI) √ √ 1
Room 100 RHT √ √ 1
Room 100A RHT √ √ 1
By FACP S (C2M PDI) √ √ 3
By FACP M √ √ 3
Main Entrance H/S √ √ S-B
Main Entrance M √ √ 3
Main Entrance S (C2M PDI) √ √ 3
Room 102 RHT √ √ 3
Room 102C RHT √ √ 3
Fan Room 102C HT √ √ 3
Room 102A RHT √ √ 3
Room 102B (Sprinkler Room) ESV 10
Room 102B (Sprinkler Room) ESV 6
Room 102B (Sprinkler Room) F/S 9 Not Tested North Wing
Not Tested By AEI
By AEI
Room 102B (Sprinkler Room) F/S 5 South Wing

Room 102B (Sprinkler Room) ESV 7

Room 102B (Sprinkler Room) ESV 8
Room 102B (Sprinkler Room) EOL √ √ 10
Room 102B (Sprinkler Room) EOL √ √ 6 Elec. Test

Room 102B EOL √ √ 9

Room 102B EOL √ √ 5
Room 102B EOL √ √ 7

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 1825 Hogan Drive, Sarnia Building Name: Gregory A. Hogan Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 102B EOL √ √ 8
Gym Entrance S (C2M PDI) √ √ 3
Room 108 HT √ √ 3
Room 104 RHT √ √ 3
Fan Room 10 HT √ √ 3
Gym H/S √ √ S-A Elec. Test

Exit By 114 M √ √ 3
Exit By Scoreboard EOL √ √ 3
Exit By Scoreboard M √ √ 3
Room 114 RHT √ √ 3
Room 114 RHT √ √ 3
By 101 H/S √ √ S-A
By 110 RHT √ √ 3
By 103 S (1400A) √ √ 3
Barrier Free Washroom HT √ √ 3
By 105 S (C2M PDI) √ √ 3
Sink Room RHT √ √ 3
Room Across from 105 RHT √ √ 3
Room 105 RHT √ √ 3
Room 105A RHT √ √ 3
By 105 H/S √ √ S-B
By 105/114 S (C2W BA) √ √ 2
Exit By 114 S (C2M PDI) √ √ 2
Exit By 114 M √ √ 2
Room 105 RHT √ √ 2
By 105 H/S √ √ S-A

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 1825 Hogan Drive, Sarnia Building Name: Gregory A. Hogan Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

By 116 S (C2M PDI) √ √ 4 5
Fan Room By 116 HT √ √ 4
107 Girls Washroom RHT √ √ 4
109 Boys Washroom RHT √ √ 4
Boiler Room 118 H/S √ √ S-B

Boiler Room 118 RHT √ √ 4

Boiler Room 118 RHT √ √ 4
By Room 118 S (C2M PDI) √ √ 4
By Room 111 H/S √ √ S-B
Fan Room By 120 HT √ √ 4
Fan Room By 122 HT √ √ 4
Fan Room By 111 HT √ √ 4
Fan Room By 113 HT √ √ 4
By 113 H/S √ √ S-A
By 113 EOL √ √ 2
By 113 S (C2W BA) √ √ 4
By 124 S (C2M PDI) √ √ 4
By 115 H/S √ √ S-B
By 126 S (C2M PDI) √ √ 4
By 117 H/S √ √ S-A
By 128 EOL √ √ 4
Exit By 128 M √ √ 4
Exit By 128 S (C2M PDI) √ √ 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 1825 Hogan Drive, Sarnia Building Name: Gregory A. Hogan

LOCATION MODEL # BATTERY # A B C D REMARKS

Gym Exit to Hall RG12S36 PS12V33 (09) 9 13.88 11:39 1170 X See Repairs List
Gym Exit By 229-240 RG36LMC 6V7.2 (09) 2 6.57 11:49 241 X See Repairs List
Gym Exit Left RG36LMC 6V7.2 (09) 2 6.76 11:50 230 X See Repairs List
Gym Exit Right RG36LMC 6V7.2 (09) 2 6.00 11:41 N/A X See Repairs List

Rm. 137 NV12250 (3) 12V7 (14) 10 13.65 11:34 710

Storage Rm. 118 (Boiler) RG12S36 12V33 (09) 10 13.91 1:15 1200
Exit By 128 RGB6LMC (2) 6V7 (13) 2 13.69 1:17 330
Room Across from 105 SLA636 6V7 (15) 2 6.89 1:19 300
Kindergarten Coatroom 121B SLA636 (2) 6V4.5 (13) 2 13.45 11:37 440
Kindergarten Coatroom 129B SLA636 (2) 6V4.5 (14) 2 13.79 11:35 371
Room 137 Exit SLA636 (2) 6V4.5 (14) 2 13.71 11:32 368
Room 125 NV12250 (3) 12V7 (14) 8 13.61 11:30 1618

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs not Required

Emergency Lighting
1 Gym Exit to Hall RG12S36 Replaced Battery w/ (1) Panasonic PA-12V33 08/09/2016
2 Gym Exit By 229-240 RG36LMC Replaced Battery w/ (1) Panasonic PA-6V7.2 08/09/2016
3 Gym Exit Left RG36LMC Replaced Battery w/ (1) Panasonic PA-6V7.2 08/09/2016
4 Gym Exit Right RG36LMC Replaced Battery w/ (1) Panasonic PA-6V7.2 08/09/2016

Hydrant Inspection
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: Gregory A. Hogan

Address: 1825 Hogan Dr. Inspector: T.Neves
City/Prov: Sarnia Date: July 6, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:
a) Are the hydrant(s) free from obstructions and accessible? YES
b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:
a) Was a flow test done? YES
b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply

3. FIRE HYDRANTS:
a) Was the hydrant valve found? YES
b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
South Hydrant:
i) The static pressure was? 65
k) The pitot reading from an engineered playpipe was 16 Using an outlet size of 2.5
l) The USGPM results are? 671
North Hydrant:
i) The static pressure was? 63
k) The pitot reading from an engineered playpipe was 16 Using an outlet size of 2.5
l) The USGPM results are? 671

1825 Hogan Street wo#21428 July 2016 Insp.xls 1

 4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #6 have been completed.

7. The following items are recommendations only.

NONE

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an

insurer and is NOT warranting or guaranteeing the adequacy, performance or life
expectancy of any structure, item, component or system in the building. Further, it is
mutually agreed that the maximum amount of joint and several liability the INSPECTOR can
incur for any error, mistakes, omissions, breach of contract, breach of warrantee, negligent
hiring, or any other theory of liability including violation of a statute or consumer protection
act is strictly limited to the FEE PAID for the inspection report.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

1825 Hogan Street wo#21428 July 2016 Insp.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 9th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
GREGORY A. HOGAN 1825 HOGAN DRIVE, SARNIA

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: August 9th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 25th, 2016

Building Name: George P. Vanier

Address: 20 Cecile Avenue, Chatham

Security/Fire Alarm Panel [Make / Model]: Mircom FA-300

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ___________________________

CFAA #: 19-996582 CFAA #: _________________________

Signature: _____________________________ Signature: ________________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name Damar Syst. # 883326 Tiger Den
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Main Entrance
Control unit or transponder location
Mircom FA-300
Control unit or transponder identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Electrical Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Panasonic LCR1212P
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 27.49
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.45
in supervisory condition Current (A) 0.180
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.80
in full load condition Current (A) 1.62
The charging current is Current (mA) 220

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test; √

(iv) A battery capacity meter test; or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 12
Record the battery terminal voltage after tests are completed. VDC 25.60

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 5.13
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders √

Tie to Security √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: George P. Vanier Address: 20 Cecile Ave, Chatham Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

West Exit by Room 134 M √ √ 1
Hall By Room 134 S √ √ 1
NAC
Hall By Room 134 H/S √ √ 3
Room 133 Exit M √ √ 1

Room Across From 133 RHT √ √ 1

Hall By Room 9 S √ √ 1
NAC
Hall By Room 9 H/S √ √ 2

Exit By Tiger Mural M √ √ 1

Hall By Resource Room S √ √ 1
Resource Room RHT √ √ 1
Room Across From Resource Room RHT √ √ 1
Kitchen (Breakfast Club) HT √ √ 1 Elect. Tested
NAC
Hall By Men's Washroom H/S √ √ 3

Hall By Women's Washroom S √ √ 1

Main Lobby S √ √ 1
Main Lobby H/S √ √ 1

Main Lobby M √ √ 1
Main Lobby Aux Relay √ √ 1
Entrance to Library DH √ √ 1
NAC
Library H/S √ √ 1

Library Storage (Right) RHT √ √ 1

Library Storage (Left) RHT √ √ 1
Hall By Office S √ √ 1
Office RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: George P. Vanier Address: 20 Cecile Ave, Chatham Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Principal's Room RHT √ √ 1

Custodian Hallway S √ √ 1
Custodian Storage RHT √ √ 1
Custodian Electrical RHT √ √ 1

Custodian Office RHT √ √ 1

NAC
Hall By Room 107 H/S √ √ 2
Storage in Room 107 RHT √ √ 1

Staff Room Hallway S √ √ 1

Staff Copy Room RHT √ √ 1
Staff Lounge (Right) RHT √ √ 1

Staff Lounge (Left) HT √ √ 1

Hall By Staff Room S √ √ 1
NAC
Hall By Boys Washroom H/S √ √ 1

Storage in Room 110 RHT √ √ 1

Storage in Room 111 RHT √ √ 1
Hall By Room 111 S √ √ 1

Hall By Room 113 S √ √ 1

NAC
Hall By Room 113 H/S √ √ 1

Storage in Room 113 RHT √ √ 1

Storage in Room 114 RHT √ √ 1
Paper Storage Room 115 RHT √ √ 1
Hall By Chemistry Storage S √ √ 1
Chemistry Storage Room 116 HT √ √ 1 Elect. Tested

Storage Room 117 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: George P. Vanier Address: 20 Cecile Ave, Chatham Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Chemical Storage RHT √ √ 1
NAC
By Slop Sink Room H/S √ √ 2

In Slop Sink Room RHT √ √ 1

Custodian Room 119 RHT √ √ 1
Hall By Room 2 S √ √ 1
NAC
Room 5 H/S √ √ 1
Storage in Room 118 RHT √ √ 1
NAC
Hall By Room 118 H/S √ √ 1

Hall By Room 118 S √ √ 1

Coat Room - Rm 1 RHT √ √ 1
Paint Storage RHT √ √ 1

East Exit M √ √ 1
Garbage Storage HT √ √ 1
Hall By Girls Changeroom S √ √ 1

Girls Changeroom RHT √ √ 1

Boys Changeroom RHT √ √ 1
NAC
Hall By Boys Changeroom H/S √ √ 2

Hall By Gym S √ √ 2
Exit By Gym M √ √ 2
NAC
Storage in Room 120 H √ √ 2
Room Coat Room 120 RHT √ √ 1

Gym West Exit M √ √ 2

Gym East Exit M √ √ 2
Storage Room 120 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: George P. Vanier Address: 20 Cecile Ave, Chatham Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym Storage RHT √ √ 2
Gym Under Stage RHT √ √ 2
Gym Area # 1 RHT √ √ 2 Caged

Gym Area # 2 RHT √ √ 2 Caged

Gym Area # 3 RHT √ √ 2 Caged

Gym Area # 4 RHT √ √ 2 Caged

Gym Area # 5 RHT √ √ 2 Caged

Gym Area # 6 RHT √ √ 2 Caged

Gym Area # 7 HT √ √ 2 Elect. Tested Caged

Gym Area # 8 HT √ √ 2 Elect. Tested Caged

Gym Area # 9 HT √ √ 2 Elect. Tested Caged

Gym Stage RHT √ √ 2

Room 121 Coat Room RHT √ √ 1
Room 121 Coat Room H/S √ √ NAC 2

Room 121B RHT √ √ 1

Room 121B H √ √ NAC 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: George P. Vanier Address: 20 Cecile Ave, Chatham

LOCATION MODEL # BATTERY RH # A B C D REMARKS

By Room 134 SPEXS636 (2) Sota 6V4.5 (12) 2 13.89 11:42 320 Ok
Exit By Tiger Mural SPEXS636 CSB 6V4.5 (13) 2 6.78 11:44 329 Ok
Hall @ Resource SPEXS636 (2) PA-6V4.5 (09) 2 13.90 11:46 340 X See Repairs List
Library SPEXS636 (2) PA-6V4.5 (13) 2 14.06 11:48 300 Ok
Library Classroom RG-36 PA-6V7.2 (09) 2 6.86 11:50 150 X See Repairs List
Front Entrance SPEXS636 (2) PA-6V4.5 (08) 2 14.06 11:52 360 Ok
Hall @ Office SPEXS636 (2) PA-6V4.5 (09) 2 14.01 11:54 380 X See Repairs List
East Exit SPEXS636 (2) PA-6V4.5 (11) 2 14.89 11:56 310 Ok
Hall Intersection to Gym SPEXS636 (2) PA-6V4.5 (09) 2 14.09 11:58 290 X See Repairs List
Hall @ Boys Changeroom SPEXS636 (2) PA-6V4.5 (10) 2 14.07 12:00 295 X See Repairs List
Exit By Gym Entrance SPEXS636 (2) PA-6V4.5 (09) 2 14.00 12:02 315 X See Repairs List
Gym Exit to Hall SPEXS636 (2) PA-6V4.5 (12) 2 14.07 12:04 320 Ok
Gym Exit -Right SPEXS636 (2) Sota 6V4.5 (12) 2 14.00 12:06 330 Ok
Gym Exit -Left SPEXS636 (2) PA-6V4.5 (14) 2 14.16 12:08 360 Ok
Room 133 Exit Sign N/A Ok

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
No Repairs Required

Emergency Lighting
1 Hall @ Resource SPEXS636 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016
2 Library Classroom RG-36 Replaced Battery w/ (1) Panasonic PA-6V7.2 07/25/2016
3 Hall @ Office SPEXS636 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016
4 Hall Intersection to Gym SPEXS636 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016
5 Hall @ Boys Changeroom SPEXS636 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016
6 Exit By Gym Entrance SPEXS636 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 25th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
GEORGE P VANIER~ 20 CECILE AVENUE, CHATHAM
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 25th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 4th, 2016

Building Name: Good Shepherd

Address: 4 Edith St., Thamesville

Security/Fire Alarm Panel [Make / Model]: Edwards EST Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs not Required

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was
left in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for
examination by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ___________________________

CFAA #: 19-995199 CFAA #: __________________________

Signature: ____________________________ Signature: ________________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883339 Gryphons
Phone Number (800) 265-7562.
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Front Entrance

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Front Entrance
Circuit breaker or disconnect means location Electrical Room 141

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Main- (2) Enersys NP7-12T
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.70
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in supervisory condition Current (A) 0.162
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in full load condition Current (A) 0.225
The charging current is Current (mA) 298
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 26.00

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 4.02
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Front Entrance
Circuit breaker or disconnect means location Electrical Room 141

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Booster- (2) Enersys NP7-12T
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.50
in supervisory condition Current (A) 0.410
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in full load condition Current (A) 0.460
The charging current is Current (mA) 292
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 25.70

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 1.22
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(I) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location Front Entrance
Control Unit or Transponder Identification EST
Data Communication link identification Loop

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders (Not Through FA Panel) √

Fan Shutdown √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 4th, 2016

Building Name: Good Shepherd Address: 4 Edith Street, Thamesville Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 101 at C1 M √ √ I27 1

Room 101 RHT √ √ 005 1

At 101C1 RHT √ √ 006 1

102A Room RHT √ √ 007 1

Storage 102B RHT √ √ 008 1

Room 102C RHT √ √ 009 1

Hall By 103 S √ √ 010 1

103 Coat Room S √ √ 011 1

103 Closet B RHT √ √ 012 1

104 Coat Room S √ √ 013 1

104 Closet B RHT √ √ 014 1

Hall By Washroom 105 H √ √ NAC 2

Office 107 RHT √ √ 024 1

Storage 106 RHT √ √ 015 1

Storage 108 RHT √ √ 016 1

Mechanical Room 109 RHT √ √ 023 1

Hall @ 111 S √ √ 019 1

111 Coat Room S √ √ 021 1

111 Closet B RHT √ √ 022 1

Room 110 Coat Room S √ √ 018 1

110 Closet B RHT √ √ 017 1

At Fire Doors S √ √ 020 1

Hall Doors @ 111 Door Holders √ √

West of Doors S √ √ 025 2

Mechanical Room 113 RHT √ √ 027 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 4th, 2016

Building Name: Good Shepherd Address: 4 Edith Street, Thamesville Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Hall By 115 H √ √ NAC 1 EOL

Hall By 115 C3 S √ √ 028 2

Room 115 A S √ √ 029 2

115 Exit M √ √ 130 2

Exit By 115 C3 North Exit M √ √ 129 2

Room 112 RHT √ √ 031 2

Hall By 112 C4 CE S √ √ 026 2

Custodial Room 117 RHT √ √ 032 2

Room 117A RHT √ √ 063 2

Room 114 RHT √ √ 038 2

Room 116 S √ √ 045 2

116 Exit M √ √ 132 2

116B RHT √ √ 039 2

Room 118 Exit M √ √ 133 2

118 S √ √ 037 2

Room 123 S √ √ 033 2

123 Exit M √ √ 131 2

Hall By 123 H √ √ NAC 2

Hall By 125 C4 WC S √ √ 036 2

125 Chapel RHT √ √ 030 2

Library (Room 124) RHT √ √ 040 2

Library H √ √ NAC 2

Hall By Door to Lobby S √ √ 035 2 Relay

Lobby by Doors S √ √ 034 2 Relay

Fire Doors Door Holders √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 4th, 2016

Building Name: Good Shepherd Address: 4 Edith Street, Thamesville Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Women's Washroom 120 RHT √ √ 041 2

Men's Washroom 122 RHT √ √ 042 2

Main Entrance M √ √ 136 3

Main Electrical Room 141 M √ √ 135 4

Main Electrical Room 141 S √ √ 043 4

Lobby By Washrooms S √ √ 046 2 High

Lobby By 133 S √ √ 044 2 High

Room 131 H √ √ NAC 2

131 Exit M √ √ 128 3

133 Kitchen RHT √ √ 047 3

137 Stage RHT √ √ 053 3

Hall By Library H √ √ NAC 1

Hall By Library S √ √ 051 3

Exit By Library M √ √ 134 3

Gym 135 H √ √ NAC 2

Gym Storage 135D- East RHT √ √ 052 3

Gym Left - Storage West RHT √ √ 050 3

Gym Exit Stair M √ √ 154 3

Girl's Change Room- West RHT √ √ 059 3

Boy's Change Room- East RHT √ √ 060 3

Outside Storage 139 RHT √ √ 049 3

Outside Storage 139 M √ √ 153 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 4th, 2016

Building Name: Good Shepherd Address: 4 Edith Street, Thamesville

LOCATION MODEL # BATTERY # A B C D REMARKS

Hall East at 103 Lumacell Headpro PE-6V7.2 2 6.79 12:47 260 Ok
Hall at 111 Lumacell Headpro PE-6V7.2 2 6.69 12:47 261 Ok
South Hall at 115 Lumacell Headpro PE-6V7.2 2 6.88 12:47 250 Ok
Hall at 117 Custodian Lumacell Headpro PA-6V7.2 (13) 2 6.99 12:47 310 Ok
Hall at 118 Lumacell Headpro PA-6V7.2 (14) 2 6.75 12:47 300 Ok
Hall By Lobby Washroom's Lumacell Headpro PA-6V7.2 (15) 2 6.69 12:47 270 Ok
Hall at Main Entrance Lumacell Headpro PE-6V7.2 2 6.85 12:47 275 Ok
Main Office Lumacell Headpro PA-6V7.2 (13) 2 6.75 12:47 281 Ok
Lobby at Staff Room Lumacell Headpro PA-6V7.2 (15) 2 6.72 12:47 240 Ok
131 Community Room Lumacell Headpro PA-6V7.2 (13) 2 6.71 12:47 264 Ok
Stage Right Lumacell Headpro PE-6V7.2 2 6.65 12:47 250 Ok
Stage Left Lumacell Headpro PE-6V7.2 2 6.79 12:47 259 Ok
Lobby at Wheelchair Ramp Lumacell Headpro PA-6V7.2 (13) 2 6.89 12:47 270 Ok
Library South Lumacell Headpro PA-6V7.2 (14) 2 6.88 12:47 281 Ok
Library North Lumacell Headpro PE-6V7.2 2 6.85 12:47 283 Ok
Exit By Library Lumacell Headpro PA-6V7.2 (13) 2 6.82 12:47 291 Ok
Gym NW Lumacell Headpro PA-6V7.2 (15) 2 6.79 12:47 281 Ok
Gym SW Lumacell Headpro PE-6V7.2 2 6.79 12:47 301 Ok
Gym SE Lumacell Headpro PE-6V7.2 2 6.72 12:47 305 Ok
Gym NE Lumacell Headpro PE-6V7.2 2 6.71 12:47 310 Ok
Girls Changeroom Lumacell Headpro PE-6V7.2 2 6.75 12:47 300 Ok
Boys Changeroom Lumacell Headpro PA-6V7.2 (15) 2 6.74 12:47 255 Ok
Outside Electrical at Main Entrance Lumacell Headpro PA-6V7.2 (13) 2 6.73 12:47 287 Ok

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST
REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs not Required

Emergency Lighting
Repairs not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 4th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
GOOD SHEPHERD~ 4 EDITH STREET, THAMESVILLE
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Kevin Bury DATED: August 4th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 8th, 2016

Building Name: Holy Family

Address: 649 Murray Street, Wallaceburg

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed as of August 31st

I A copy of this report has been given to: St. Clair Catholic District School Board

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: __________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883327 (Cardinals)
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Electrical Room # 106

Control unit or transponder identification Edwards 6616

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room # 106
Circuit breaker or disconnect means location Electrical Room # 106

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (4) Panasonic LCR0612P
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in supervisory condition Current (A) 0.255
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.90
in full load condition Current (A) 0.76
The charging current is Current (mA) 333
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 25.50

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 6.51
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification EST

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Holy Family Address: 649 Murray Street, Wallaceburg Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym HT √ √ 3 High

Gym HT √ √ 3 High

Gym HT √ √ 3 High

Gym HT √ √ 3 High

Under Stage at Gym Storage RHT √ √ 3

Gym Exit M √ √ 3

Gym West Exit M √ √ 3

Gym B √ √ S-1

Gym Storage RHT √ √ 3 High

Gym Stage HT √ √ 3

Storage By Stage RHT √ √ 2 EOL

Exit By Gym M √ √ 2

Hall By Boy’s C / R S (C2M PDI) √ √ 2

Boy’s Change Room HT √ √ 2 Elec. Test

Hall By Girl’s C / R 129 B √ √ S-1

Girl’s Change Room 129 RHT √ √ 2

Hall By Girl’s C / R at 129 S (C2M PDI) √ √ 2

Room 132 HT √ √ 2 Elec. Test

Room 134 HT √ √ 2 Elec. Test

Hall By Room 132 B √ √ S-1

Hall By Room 132 S (C2M PDI) √ √ 2

Exit By Room 132 M √ √ 2

Hall By Room 127 S (1400A) √ √ 1

Hall By Room 127 B √ √ S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Holy Family Address: 649 Murray Street, Wallaceburg Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Boiler Room South 123 HT √ √ 1 Elec. Test

Hall By Room 111 S (1400A) √ √ 1

Boiler Room 123 HT √ √ 1 Elec. Test

Staff Locker Room 126 RHT √ √ 1

Staff Lounge 126 RHT √ √ 1
Room 10 Closet 121A RHT √ √ 1
Paper Storage 124 Book Room RHT √ √ 1
Custodian Room 111 RHT √ √ 1
Hall By Girl’s W/C at 117 B √ √ S-1

Hall By Girl’s W/C at 117 S (1400A) √ √ 1

Coat Room 115 RHT √ √ 1
Room Closet 115 A RHT √ √ 1
Staff Washroom 120 RHT √ √ 1
A.V. Room 118A RHT √ √ 1
Canteen 118 RHT √ √ 1
Teacher’s Work Rm 113 RHT √ √ 1
Library Front 116 RHT √ √ 1
Library/ Room 116 B √ √ S-1

Library Rear 116A RHT √ √ 1

Library Exit 116 M √ √ 1
Hall By Library at 116 S (1400A) √ √ 1
Exit By Library at 116 M √ √ 1
Hall By 120 Staff Washroom S (1400A) √ √ 1
Custodian Room 119 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Holy Family Address: 649 Murray Street, Wallaceburg Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall at Music Room 125 S (1400A) √ √ 1
Room 6 Coat Room 114 RHT √ √ 1
Room 6 Closet 114A RHT √ √ 1
Room 5 Coat Room 109 RHT √ √ 1
Room 5 Closet 109A RHT √ √ 1
Art Supplies 112 RHT √ √ 1
Hall By Computer Room / Library 107 B √ √ S-1

Hall By Computer Room S (1400A) √ √ 1

Computer Room RHT √ √ 1
Computer Room Exit M √ √ 1
Computer Office RHT √ √ 1
Front Resource Room RHT √ √ 1
Rear Resource Room RHT √ √ 1
Boiler Room M √ √ 1
Boiler Room HT √ √ 1 Elec. Test

Lobby By Office S (1400A) √ √ 1

Lobby By Office B √ √ S-1

Side Lobby M √ √ 1
Front Door M √ √ 1
Office RHT √ √ 1
Office Storage RHT √ √ 1
Front Door ANN √ √

Front Entrance RHT √ √ 1

Boiler Room South 123 #4 ESV √ √ 8 Alarm Zone

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Holy Family Address: 649 Murray Street, Wallaceburg Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Boiler Room 123 #2 ESV √ √ 7 Alarm Zone

Boiler Room 123 #3 ESV X 6 Disconnected

Boiler Room 123 #4 ESV X 5 Disconnected

Boiler Electrical Room 106 ESV √ √ 11 Alarm Zone

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: Holy Family Address: 649 Murray Street, Wallaceburg

LOCATION MODEL # BATTERY # A B C D REMARKS

Boiler Room RG 12S 360 PA-1233 (11) 8 13.35 12:36 120 Ok
Canteen Room RG 12S 360 PA-1233 (12) 8 13.45 12:38 110 Ok
Small Boiler Room RG 12S 360 PA-1233 (14) 15 13.50 12:40 950 Ok
Porta Pak Hall West JML 36 PA-6V12 (11) 2 6.81 12:43 111 Ok
By Girl’s Change Room RG 12S 360 NP33-12 (15) 8 13.61 12:48 115 Ok

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm
1 Fire panel buzzer failed, replaced panel w/ system as other issues were found. 08/24/2016
2 (2) valves not in use, have been disconnected from system. Other valves were not supervised, are 08/24/2016
now supervised upon installation of the new panel

Emergency Lighting
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: Holy Family

Address: 649 Murray Street Inspector: T.Neves
City/Prov: Wallaceburg Date: July 22, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:
a) Are the hydrant(s) free from obstructions and accessible? YES
b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:
a) Was a flow test done? YES
b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply

3. FIRE HYDRANTS:
a) Was the hydrant valve found? YES
b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
i) The static pressure was? 72
k) The pitot reading from an engineered playpipe was 12 Using an outlet size of 2.5
l) The USGPM results are? 581

649 Murray Street wo#21428 Aug 2016 Insp.xls 1

4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #7 have been completed.

7. The following items are recommendations only.

NONE

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.
As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

Notes:
Hydrant @ back of the property.

649 Murray Street wo#21428 Aug 2016 Insp.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
HOLY FAMILY~ 649 MURRAY STREET, WALLACEBURG

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Kevin Bury DATED: August 24th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: _ July 11th, 2016

Building Name: Holy Rosary

Address: 715 London Road, Wyoming

Security/Fire Alarm Panel [Make / Model]: Edwards EST Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing of
D Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

I A copy of this report has been given to: Paul Lernout- SCCDSB

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ___________________________

CFAA #: 19-996382 CFAA #: __________________________

Signature:______________________ Signature:______________________
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation: X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name Damar -Rams 114869
Phone Number (800) 865-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Boiler Room 109

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Boiler Room 109
Circuit breaker or disconnect means location Boiler Room 109

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed
Battery manufacturer and part number DSW12-18
Battery manufacturer's date code or ins service date Date 2010
Battery Voltage (main power supply 'ON') is Voltage 27.26
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.40
supervisory condition Current (A) 0.43
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 24.70
full load condition Current (A) 1.82
The charging current is Current (mA) 0.45
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test; √

(iv) A battery capacity meter test; or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 18
Record the battery terminal voltage after tests are completed. VDC 26.80

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 24 x 0.43 + 0.91= 11.23
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements
√

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location
Annunciator or remote trouble signal unit identification

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s)
√

Specify method of confirmation: Both √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Front Entrance
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations
Remote trouble signal unit identification

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location
Printer Identification

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location
Control Unit or Transponder Identification
Data Communication link identification

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble, Supervisory) √

Door Holders √

Fan Shutdown √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Address: 715 London Road, Wyoming Building Name: Holy Rosary Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Front Entrance ANN √ √

Front Entrance M √ √ 1 126

Front Entrance H/S √ √ S-1 EOL

Front Entrance S (SIGA) √ √ 1 002

Rm 101 H √ √ S-2

Rm 101/ Work Rm. RHT √ √ 1 003

Rm 102 H √ √ S-2

Hall By 107 H/S √ √ S-1

105 H √ √ S-2

107 H √ √ S-2

Hall By Boys Washroom S (SIGA) √ √ 1 005

Mech. Rm. 109 H/S √ √ S-1

Mech. Rm. 109 RHT √ √ 1

Boiler Room H/S √ √ S-1

Boiler Room RHT √ √ 1 007

Gym Stage RHT √ √ 1 009

Gym Storage By 113B RHT √ √ 1 011

Gym Exit 113B M √ √ 1 127

Gym Under Stage RHT √ √ 1 010

Gym Stage H/S √ √ S-1

Gym West H/S √ √ S-1

Gym East H/S √ √ S-1

Hall By 104 H/S √ √ S-1

Hall By 103 S (SIGA) √ √ 1 008

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Address: 715 London Road, Wyoming Building Name: Holy Rosary Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Class 104 H √ √ S-2

Class 106 H √ √ S-2

Class 106 (Library) RHT √ √ 1 001

Hall By 106 H/S √ √ S-1

Hall By 106 to Gym S (SIGA) √ √ 1 012

Servery Rm 115 Front (Staff RM) RHT √ √ 1 014

Servery Rm 115 Rear (Rm 107A) RHT √ √ 1 013

Servery Rm 115 Rear M √ √ 1 128

Servery 115 H √ √ S-2

Hall By 115 (Staff Rm) S (SIGA) √ √ 1 015

Rm 117 H √ √ S-2
Rm 108 H √ √ S-2
Rm 108 SA (110V) √ √ 2011 Not wired to Fire Panel
Corner by 106 (108) S (SIGA) √ √ 1 016

Hall By 119 H/S √ √ S-1

PortaPak NW Exit M √ √ 2 129

PortaPak By Rm. 121 S (SIGA) √ √ 2 021

Rm 121 H √ √ S-2
Rm 121 RHT √ √ 2 022

Rm 123 RHT √ √ 2 024

Custodian Rm/ Water Rm 123A RHT √ √ 2 023

Rm 110 H √ √ S-2
Rm 112 H √ √ S-2
Hall By 110 H/S √ √ S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Address: 715 London Road, Wyoming Building Name: Holy Rosary Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall By 110/129 (T102) S (SIGA) √ √ 2 025

Rm 129 H √ √ S-2
By Room 129 M √ √ 2 130

Room 129 SA (110V) √ √ 2011 Not wired to Fire Panel

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: Holy Rosary Address: 715 London Road, Wyoming

LOCATION MODEL # BATTERY # A B C D REMARKS

Mech. Room 109 SLD 24720 (2) STD-12V32AH (15) 10 27.61 3:47 1.36
Porta Pak NW Door SLC 636 Standard 6V5 (15) 2 6.98 3:46 0.24
Porta Pak Hall @ 125 SLC 636 Standard 6V5 (15) 2 6.94 3:46 0.25
Gym Storage SLD 24720 (2) STD-12V35AH (14) 8 13.43 3:45 0.98

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Edwards EST Quickstart FA Panel Replace batteries w/(2) Enersys NP18-12 07/11/2016

Emergency Lighting
Repairs not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete
building audit of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the
authority having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 11th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
HOLY ROSARY, 715 LONDON STREET, WYOMING
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 11th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 8th, 2016

Building Name: Holy Trinity

Address: 60 Lorne Crescent, Sarnia

Security/Fire Alarm Panel [Make / Model]: Edwards EST Quickstart 4

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs not Required

I A copy of this report has been given to: St. Clair Catholic District School Board

Who is the; Owner X or Owner's Representative for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: _ Alban Berisha Name: ______________________

CFAA #: 19-996382 CFAA #: _____________________

Signature: ______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114623- Tigers
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room 153

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 153
Circuit breaker or disconnect means location Room 105A

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number FACP -Enersys NP18-12 Booster- Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2015 2015
Battery Voltage (main power supply 'ON') is Voltage 27.30 26.89
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 25.59 25.79
system in supervisory condition Current (A) 0.13 0.27
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 24.78 25.66
system in full load condition Current (A) 2.620 0.95
The charging current is Current (mA) 0.99 0.30
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH FACP - 18 Booster- 7
Record the battery terminal voltage after tests are completed. VDC 26.9 26.6

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): FACP=7.79 Booster=3.345
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Main Entrance
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification Annun./ Loop 1

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble, Supervisory) √

Door Holders √

Fan Shutdown √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Main Entrance Ann. √ √

Main Entrance M √ √ WEST 126

General Office South 100D S (Siga PS) √ √ WEST 001

General Office North 100D S (Siga PS) √ √ WEST 002

Front Lobby Southwest - High S (Siga PS) √ √ WEST 003

Front Lobby Northwest - High S (Siga PS) √ √ WEST 004

Front Lobby Northeast - High S (Siga PS) √ √ WEST 005

Front Lobby Southeast - High S (Siga PS) √ √ WEST 020

Front of General Office CR √ √

Above Ceiling by W/C 104 - High S (Siga PS) √ √ WEST 006

Above Ceiling by Room 108 - High S (Siga PS) √ √ WEST 007

Above Ceiling By Gym Lobby-High S (Siga PS) √ √ WEST 008

West Hall By Room 110 S (Siga PS) √ √ WEST 009

Room 107 CR √ √

West Hall By Room 114 S (Siga PS) √ √ WEST 010

Penthouse- Top of Stair M √ √ 142

Penthouse S (Siga PS) √ √ PH 045

EAST/
Penthouse Main Floor Return DS √ √ WEST 048

Penthouse Gym Return DS √ √ GYM 046

EAST/
Penthouse W/C Return DS √ √ WEST 047

West Hall By Room 116 S (Siga PS) √ √ WEST 011

West Hall By Room 118 S (Siga PS) √ √ WEST 012

Northwest Exit By 120 M √ √ WEST 129

North Hall By Room 119 S (Siga PS) √ √ WEST 013

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

North Hall By Room 124 S (Siga PS) √ √ WEST 014

North Hall By Room 126 S (Siga PS) √ √ WEST 017

Room 125 By Kitchen (125A) S (Siga PS) √ √ GYM 042

North Hall By Room 128 S (Siga PS) √ √ WEST 018

Northeast Exit By Room 130 M √ √ EAST 135

East Hall By Room 132 S (Siga PS) √ √ EAST 040

East Hall By Room 134 S (Siga PS) √ √ EAST 038

Storage Room 135 S (Siga PS) √ √ EAST 035

East Hall By Room 140A S (Siga PS) √ √ EAST 032

Room 140E S (Siga PS) √ √ EAST 031

Room 140E M √ √ EAST 133

East Hall By Room 140B S (Siga PS) √ √ EAST 030

East Hall By Room 149 S (Siga PS) √ √ EAST 029

East Hall By Room 150B S (Siga PS) √ √ EAST 027

Room 150E Coat Room S (Siga PS) √ √ EAST 028

Room 150E M √ √ EAST 132

Room 153 (IT Room) S (Siga PS) √ √ EAST 041

Hall By Room 160A S (Siga PS) √ √ EAST 026

East Hall By Resource (159) S (Siga PS) √ √ EAST 024

Southeast Coat Room 160E S (Siga PS) √ √ EAST 025

Southeast Coat Room Exit 160E M √ √ EAST 131

Southeast Exit By 159 M √ √ EAST 130

Southeast Hall By Resource S (Siga PS) √ √ EAST 022

South Hall East By Library S (Siga PS) √ √ EAST 021

Southwest Hall By Library S (Siga PS) √ √ EAST 023

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM- Other Devices
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

North Hall By 124 IM √ √ 015

North Hall By 126 IM √ √ 016

Storage Room 135 IM √ √ 033

Storage Room 135 IM √ √ 034

Kitchen IM √ √ 036

Kitchen IM √ √ 037

Hall @ 134 IM √ √ 039

Sprinkler Room IM √ √ 043

Outdoor Storage Room IM √ √ 044

Penthouse IM √ √ 049

Penthouse IM √ √ 050

Kitchen CR √ √ 134

Booster Trouble CTI √ √ 149

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 1 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Hall By 160A H/S √ √ 2
Kindergarten 160A Coat Room H/S √ √ 2
Kindergarten 160A H/S √ √ 1
Hall @ F/A Room H/S √ √ 1

Room 150A H/S √ √ 1

150A Coat Room H/S √ √ 2
Hall By 140B H/S √ √ 2
Room 140A H/S √ √ 1
Room 140 Coat Room H/S √ √ 2
Hall By 135 H/S √ √ 1
Hall By 132 H/S √ √ 2
Hall By 128 H/S √ √ 1
Hall By 124 H/S √ √ 2
125 (Stage East) H/S √ √ 2
Gym Stage West H/S √ √ 1
Hall By 118 H/S √ √ 1
Hall By 114 H/S √ √ 2
Penthouse East H/S √ √ 2

Penthouse West H/S √ √ 1

Hall By 108 H/S √ √ 1

Hall By Staff Room H/S √ √ 2

Gym Southwest H/S √ √ 2
Gym Northwest H/S √ √ 2
Gym Northeast H/S √ √ 1
Gym Southeast H/S √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 2 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS

Staff Room H/S √ √ 1
Front Entrance H/S √ √ 1
Hall By Library H/S √ √ 2

Library West H/S √ √ 1

Library East H/S √ √ 2
Hall By Library H/S √ √ 1

At Fire Alarm Control Panel EOL √ √ 1

At Fire Alarm Control Panel EOL √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM- Sprinkler
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity Page 1 of 1

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Main Tree SV.1 ESV √ 12 √ 141

Main Tree SV.2 ESV √ 11 √ 140

East Sprinkler ESV √ 10 √ 139

West Sprinkler ESV √ 9 √ 138

East Sprinkler FS √ √ 6 137

West Sprinkler FS √ √ 5 136

Penthouse Supply Valve #3 ESV √ 13 √ 146

Penthouse SV 2.1 ESV √ 14 √ 147

Gym Sprinkler Valve 1-3 ESV √ 15 √ 148

Penthouse Sprinkler FS √ √ 7 144

Gym Sprinkler Flow FS √ √ 8 145

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 60 Lorne Crescent Building Name: Holy Trinity

# LOCATION MODEL # BATTERY A B C D REMARKS

1 Storage Room 135 RG12S250 (4) PA-6V12 (14) 13.86 3:15 Panel D

2 Room 125B Stage Storage RG12S250 (4) PA-6V12 (14) 14.01 3:15 Panel C

3 Penthouse (ST 1.1) RG12S250 (4) PA-6V12 (14) 13.49 3:15 Panel M4

4 Custodian Room 115 RG12S250 (4) PA-6V12 (15) 13.78 3:15 Panel E

5 Staffroom By Washrooms 106 RG12S250 (4) PA-6V12 (15) 13.72 3:15 Panel A

6 Elect. Rm 105A @ Front Door RG12S250 (4) PA-6V12 (15) 14.00 3:15 Panel A

7 Room 140E SLER4520MT (2) PA-6V12 (15) 13.87 3:15 DP2

8 Room 150E SLER4520MT (4) PA-6V12 (15) 13.95 3:15 DP2

9 Room 160E SLER4520MT (4) PA-6V12 (15) 13.89 3:15 DP2

*Panel Locations*
By 135-Panel D 54
By 125B- Panel C 60
Rm 115- Panel E 10
Penthouse-Panel M4 7
Rm 105A-Panel A 46/1
Penthouse-Panel DP2

A- Battery Float Voltage (AC Power On)

B- Test Start Time
C- Requires Service, Repairs, Missing
D- Repairs Completed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
Repairs Not Required

Sprinkler System & Fire Hydrant

Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
IM/ISO Isolator Module
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Anderson's Electronic's Location: Holy Trinity

Building Occupancy Type: Institutional Hazard: Light & Ordinary

Address: 60 Lorne Cres., Inspector: T.Neves
City/Province: Sarnia Ontario Date: July 8, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #15

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is the building completely sprinklered? YES
f) Are all areas accessed in the building properly protected? YES
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? YES
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? SUPERVISED
d) Did the electronic supervisory switches operate? YES

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? (1-1/4" YES

b) The static pressure was? 58
c) The residual pressure was? 48
d) Type of water supply? MUNICIPAL
e) Does the fire protection incoming water supply have a backflow preventor? YES
f) Has the backflow preventor been tested for cross contamination? NO

4. TANKS, PUMPS & SIAMESE:

a) Are siamese connections in good condition, couplings spin freely, caps in place and ball drips open? Yes
(Chrome)

60 Lorne Cres wo#21428 July 2016 Insp.xls 1

5. FIRE HYDRANTS:

a) Was the hydrant road box valve found? YES

b) Does the hydrant road box valve appear to be open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? Yes
h) Was a flow test done? YES

Hydrant # 1:
i) The static pressure was? 68
j) The pitot reading from an engineered playpipe was 34 Using an outlet size of 2.5
k) The USGPM results are? 978

6. WET SYSTEMS:

# of wet systems: Make & Model: Valve & flow switches

a) Are alarm valves in good condition? N/A

b) Are the flow switches working and in good condition? YES
c) Did the water motor gong test satisfactorily? N/A
d) Are the low pressure switches working and in good condition? N/A
e) The low pressure switch operates at? N/A
f) Is the excess pressure pump functional? N/A
g) Is the valve trimmed properly? N/A
h) The operation of the excess pressure pump is? N/A
i) The excess pressure pump automatically starts at? N/A
j) The excess pressure pump automatically stops at? N/A

7. DRY SYSTEMS: N/A

8. ANTI-FREEZE SYSTEMS: N/A

9. SPECIAL SYSTEMS: N/A

10. STANDPIPE SYSTEMS: N/A

11. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? Yes
b) Are the sprinklers less than 50 years old? (2009) Yes
c) Are there spare sprinklers and a wrench in the head cabinet? Yes
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? Yes

e) Have the sprinklers been checked for the proper temperature rating in various locations where possible? Yes

60 Lorne Cres wo#21428 July 2016 Insp.xls 2

12. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Rm 105A 4" BF Valve Backflow Incoming Operational
Rm 105A 4" BF Valve Backflow Discharge Operational
Rm 105A 4" Backflow Sprinkler System -
Rm 105A 2-1/2" B.Fly Valve East Sprinklers Operational
Rm 105A 2-1/2" Flow Switch East Sprinklers Operational
Rm 105A 3" B.Fly Valve West Sprinklers Operational
Rm 105A 3" Flow Switch West Sprinklers Operational
Stairwell 1.1 3" B.Fly Valve Main-Gym&Mech Rm Operational
Mech.Rm. 3" B.Fly Valve Mech. Rm. Sprinklers Operational
Mech.Rm. 3" Flow Switch Mech. Rm. Sprinklers Operational
Mech.Rm. 2-1/2" B.Fly Valve Gym Sprinklers Operational
Mech.Rm. 2-1/2" Flow Switch Gym Sprinklers Operational

13. LISTED ARE RECENT CHANGES IN THE BUILDING OCCUPANCY OR FIRE PROTECTION EQUIPMENT:

NONE

14. THE FOLLOWING ARE CORRECTIONS MADE AT THE TIME OF INSPECTION:

NONE

15. DEFICIENT ITEMS:

NONE

The above items are deficient as per The Ontario Fire Code and need to be corrected immediately. A certificate of inspection
cannot be issued until all items under section #15 have been addressed. Consultation with the local fire prevention office is
suggested, if discrepancies occur

16. THE FOLLOWING ITEMS ARE RECOMMENDATIONS ONLY:

NONE

17. FITTERS NOTES:

*Hydrants drain VERY slow.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify that the
sprinkler system installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report would be required to
certify this).

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT warranting or
guaranteeing the adequacy, performance or life expectancy of any structure, item, component or system in the building.
Further, it is mutually agreed that the maximum amount of joint and several liability the INSPECTOR can incur for any error,
mistakes, omissions, breach of contract, breach of warrantee, negligent hiring, or any other theory of liability including violation
of a statute or consumer protection act is strictly limited to the FEE PAID for the inspection report.

60 Lorne Cres wo#21428 July 2016 Insp.xls 3

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
HOLY TRINITY~ 60 LORNE CRESCENT, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT AND SPRINKLER SYSTEM HAVE ALSO BEEN
INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 8th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 18th, 2016

Building Name: Monsignor John Uyen

Address: 255 Lark St, Chatham

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout - SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA

Power 'ON' visual indicator √

Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and √
transmits a trouble to the fire signal receiving centre
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883328 Tigercats
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Electrical Room off Boiler Room

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room off Boiler Room
Circuit breaker or disconnect means location Electrical Room off Boiler Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP18-12B
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.40
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.60
in supervisory condition Current (A) 0.158
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.30
in full load condition Current (A) 1.661
The charging current is Current (mA) 451

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √

Record battery capacity AH 15

Record the battery terminal voltage after tests are completed. VDC 25.90

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 4.64
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Front Entrance
Annunciator or remote trouble signal unit identification EST

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO √
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders, introduce
a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Doorholders √

√
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 18th, 2016

Building Name: Monsignor John Uyen Address: 255 Lark Street, Chatham Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym Exit East M √ √ 1

Gym Left RHT √ √ 1 Mech. Tested

Gym Left B √ √ S-2 EOL

Girl’s Change Room RHT √ √ 1

Girls Change Room B √ √ S-2

Gym Exit to Hall 103 M √ √ 1

Gym Storage 103A RHT √ √ 1

Boys Change Room 105 RHT √ √ 1

Boys Change Room B √ √ S-2

Gym Right B √ √ S-2

Gym Right Storage to Outside HT √ √ 1

Gym Right Exit at Storage #16 M √ √ 1

Gym Stage RHT √ √ 1 Mech. Tested

Hall By Gym 1 B √ √ S-2

Front Entrance M √ √ 1

Secretary’s Office 100 RHT √ √ 1

Principal’s Office 102 RHT √ √ 1

Conference Room 104 RHT √ √ 1

Hall By Principal B √ √ 1
East Exit Out Gym M √ √ 1

Hall By Staff Room B S-1

Staff Room RHT 1

No Longer
Hall By Store Room B No Longer Installed S-1
Installed
In Store Room RHT 2

In Store Room B S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 18th, 2016

Building Name: Monsignor John Uyen Address: 255 Lark Street, Chatham Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Staff Room 116 RHT √ √ 2

Room 110 RHT √ √ S-1 EOL

Hall Exit at 106 M √ √ 2

Room 109 RHT √ √ S-1

Room 111 B √ √ S-2

Room 111 RHT √ √ 2 EOL

Library Exit To Hall M √ √ 2

Library at 127 RHT √ √ 2 High

Library at 136 RHT √ √ 2 High

Library at 132 RHT X 2 See Repairs List

Library at 125 B √ √ S-4

Library in 125 Rear Exit B √ √ S-4

Library in 125 Rear Exit M √ √ 2

In 127 M √ √ 2

Custodian Room RHT X 2 See Repairs List

Boy's Washroom RHT √ √ 2

Handicap Washroom RHT √ √ 2

Hall at 138 B √ √ S-4

Hall Exit at 138 M √ √ 2

Room 136 Exit M √ √ 2

Room 134 Exit M √ √ 2

Room 132 Exit M √ √ 2

113C Stock Room RHT √ √ S-4

Room 5 Off Library M 2 No Longer

No Longer Installed
2 Installed
Room 6 Off Library M

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 18th, 2016

Building Name: Monsignor John Uyen Address: 255 Lark Street, Chatham Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Room off Library 123 Exit M √ √ 2

Room off Library 113A RHT √ √ 2

Room off Library 113B RHT √ √ 2

Room 113 Hall Entrance M √ √ 2

Store Room 122 RHT √ √ 1

Hall By store Room 122 B √ √ S-3 EOL

Room 124 HT √ √ 1 Elect. Tested

Boiler Room 126 HT √ √ 1 Elect. Tested

Boiler Room Exit 126 M √ √ 1

Electrical Room 126A HT √ √ 1 Elect. Tested

Hall By 121 B √ √ S-3

Room 121 RHT √ √ 2

Hall at 119 B √ √ S-3

Hall at 121 RHT √ √ 2

Hall Exit at 121 M √ √ 2 EOL

Room Right 130 RHT √ √ 2

Room 117 at Washroom RHT √ √ 2

117 at Coat Racks RHT √ √ 2 Elect. Tested

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 18th, 2016

Building Name: Monsignor John Uyen Address: 255 Lark Street, Chatham

LOCATION MODEL # BATTERY # A B C D REMARKS

Gym Exit Left SPEXS10721 (2) PA-6V4.5 (13) 2 13.88 12:30 .500

Gym Exit Right SPEXS10721 (2) Enerwatt 6V4.5 (12) 2 13.60 12:30 .670

Gym Exit to Hall SPEXS10721 (2) PA-6V4.5 (14) 3 13.70 12:30 .801

Main Entrance SPEXS10721 (2) PA-6V4.5 (12) 3 13.97 12:30 .750

Hall By Office by Boys W/C SPEXS10721 (2) Enerwatt 6V4.5 (13) 3 13.75 12:30 .551

Hall By Principal SPEXS10721 (2) PA-6V4.5 (09) 2 13.88 12:30 .501 X See Repairs List
Hall By Locker 39 SPEXS10721 (2) Enerwatt 6V4.5 (11) 2 13.76 12:30 .675

Stage Exit SPEXS10721 (2) PA-6V4.5 (12) 2 13.56 12:30 .660

Exit By Stage Exit SPEXS10721 (2) Enerwatt 6V4.5 (12) 2 13.70 12:30 .781

Hall By Locker 74 SPEXS10721 (2) PA-6v4.5 (14) 3 13.69 12:30 .980

Hall By Room 1 SPEXS10721 (2) Enerwatt 6V4.5 (13) 4 13.81 12:30 .741

Hall By Library SPEXS10721 (2) Enerwatt 6V4.5 (11) 2 13.65 12:30 .691

Library Left Exit SPEXS10721 (2) Enerwatt 6V4.5 (12) 2 13.75 12:30 .801

Library Left By Theatre SPEXS10721 (2) PA-6V4.5 (12) 3 13.69 12:30 .767

Library Rear SPEXS10721 (2) PA-6V4.5 (09) 2 13.56 12:30 .681 X See Repairs List
Exit By Washroom SPEXS10721 (2) PA-6V4.5 (15) 2 14.01 12:30 .900

Library Right By Theatre SPEXS10721 (2) PA-6V4.5 (14) 3 13.49 12:30 .850

Library Right Exit SPEXS10721 (2) PA-6V4.5 (12) 3 13.98 12:30 .775

Library Room Exit SPEXS10721 (2) PA-6V4.5 (09) 2 13.75 12:30 .881

Boiler Room Exit SPEXS10721 (2) PA-6V4.5 (11) 3 13.81 12:30 .681

Portapac Hallway Exit SPEXS10721 (2) Enerwatt 6V4.5 (12) 2 13.78 12:30 .781

In Store Room RGC442MTIW PA-6V7.2 (12) 4 6.88 12:30 .180

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm
1 Library at 132 RHT Remounted (1) 5601A Heat Detector 08/18/2016
2 Custodian Room RHT Replaced Device w/ (1) 5601A Heat Detector 08/18/2016

Emergency Lighting
1 Hall By Principal SPEXS10721 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/18/2016
2 Library Rear SPEXS10721 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/18/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 18th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
MONSIGNOR JOHN UYEN~ 255 LARK ROAD, CHATHAM

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: August 18th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 27th, 2016

Building Name: Our Lady of Fatima Catholic School

Address: 545 Baldoon Road, Chatham

Security/Fire Alarm Panel [Make / Model]: Edwards Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs not required at this location.

I A copy of this report has been given to: SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883329 Falcons
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room 150A

Control unit or transponder identification Edwards EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 150A
Circuit breaker or disconnect means location Room 150A

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.80
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.80
in supervisory condition Current (A) 0.59
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in full load condition Current (A) 0.612
The charging current is Current (mA) 760
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 25.8

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): FACP - 6
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 150A
Circuit breaker or disconnect means location Room 150A

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Enersys NP18-12
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.50
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.50
in supervisory condition Current (A) 0.970
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.50
in full load condition Current (A) 2.70
The charging current is Current (mA) 1200
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 18
Record the battery terminal voltage after tests are completed. VDC 25.5

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): Booster- 7.73
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: Both √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Front Entrance
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location 150A
Control Unit or Transponder Identification EST
Data Communication link identification Loop

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders √

Security (Alarm, Trouble) √

√
√
√
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 1 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Main Lobby Exit M (1) √ √ 2 127

Conference Room (Centre) RHT √ √ 2

Conference Room (By Bathroom) RHT √ √ 2
Hall By Exit # 7 (Main Entr.) S √ √ 2 014

Secretary's Desk RHT √ √ 2

VP Office RHT √ √ 2
Back Hallway off of Main Office S √ √ 2 018

Back Hallway off of Main Office H/S √ √ B

Principal's Office RHT √ √ 2
Storage # 1 RHT √ √ 2
Health Room RHT √ √ 2
Hall By Washroom # 2 H/S √ √ A
Hall By Health Room (Corr. 3) S √ √ 2 020

Hall By Health Room H/S √ √ A

Storage # 3 RHT √ √ 1
Hall By Storage # 3 (Corr. 11) S √ √ 1 025

Hall By Storage # 3 H/S √ √ B

Study Room By Storage # 3 RHT √ √ 1
Hall By Boy's W/C (Corr. 11) S √ √ 1 026

Exit # 2 (Corr. 11) M (3) √ √ 1 128

Hall By Room 5 H/S √ √ A

Hall By Room 4 (Corr. 16) S √ √ 1 027

Hall By Room 2 H/S √ √ B

Hall By Room 2 (Corr. 16) S √ √ 1 028

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 2 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit By Room 2 M (2) √ √ 1 129

Exit By Room 2 (Corr. 16) S √ √ 1 029

Hall By Boy's Dressing Rm (Corr. 2) S √ √ 2 013

In Boy's Dressing Room RHT √ √ 1

In Girls Dressing Room RHT √ √ 1

Hall By Girls Dressing Room H/S √ √ A

Hall By Girls Dressing Rm (Corr. 2) S √ √ 1 011

Storage 4 RHT √ √ 1

Hall By Boys Bathroom (Corr 38) S √ √ 1 037

Exit # 5 (Corr. 45) M (5) √ √ 1 130

Exit # 5 (Corr. 38) H/S √ √ B

Exit # 5 (Corr. 45) S √ √ 1 038

Hall By Paper Storage (Corr 38) S √ √ 1 036

Paper Storage RHT √ √ 1

Hall By Chapel/12 (Corr. 32) S √ √ 1 042

Hall By Chapel/12 H/S √ √ B

Chapel RHT √ √ 1

Hall By Room 7 (Corr. 42) S √ √ 1 043

Hall By Room 11 H/S √ √ A

Coat Room off Room 9 RHT √ √ 1
Room 9 H/S √ √ B

Hall By Room 9 (Corr. 32) S √ √ 1 044

Hall By Room 10 H/S √ √ A

Hall By Room 10 (Corr. 32) S √ √ 1 045

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 3 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Storage By Exit 4 RHT √ √ 1
Exit 4 Vestibule 31 Exit M (4) √ √ 1 131

Library (Right) - Room 40 S √ √ 1 030

Library Resource- Storage 43 DS √ √ 1 033

Library (Left) Rm. 40 S √ √ 1 031

Library H/S √ √ A
French Room off Library RHT √ √ 1

Resource off Library RHT √ √ 1

Custodians Room RHT √ √ 2
Boiler Room RHT √ √ 2

Boiler Room M (6) √ √ 2 126

Boiler Room H/S √ √ A

Electrical Room RHT √ √ 2

Hall By Boiler Room- Corr. 53 S √ √ 2 012

Hall By Gym Entrance- Vestibule S √ √ 2 010

Hall By Exit 9- South Hall S √ √ 2 043

Hall By Exit 9- West Back Door Exit M (7) √ √ 2 131

Hall By Exit 9 H/S √ √ B

Storage By Exit 9 RHT √ √ 2
Hall By Prep Room- South Hall S √ √ 3 042

Prep Room (Front) RHT √ √ 3

Prep Room (Rear) RHT √ √ 3
Hall By Prep Room (s) South Hall S √ √ 3 041

Hall By Prep Room H/S √ √ B

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 4 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall By Room 14 - South Hall S √ √ 3 040

Storage By Room 14 RHT √ √ 3

Room 14 H/S √ √ B

Room 14 Storage RHT √ √ 3

Hall By Custodian Room S √ √ 3
Hall By Custodian Room H/S √ √ B
Custodian Room RHT √ √ 3
Room 13 H/S √ √ B
Room 13 Storage RHT √ √ 3
Hall By Room 13- SW Hall S √ √ 3 034

Hall By Exit 8- SW Hall S √ √ 3 033

Exit # 8 M (9) √ √ 3 130

Gym H/S √ √ A
Gym H/S √ √ B
Gym (Left) RHT √ √ 3
Gym (Right) RHT √ √ 3
Equipment Room RHT √ √ 3
Exit 6 off Gym M (8) √ √ 3 126

Gym Stage (Left) RHT √ √ 3

Gym Stage (Right) RHT √ √ 3
Gym Stage (Far Left) RHT √ √ 3
Gym Stage (Far Right) RHT √ √ 3
Storage off Gym Stage RHT √ √ 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 5 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall By Exit 10 - South Hall S √ √ 3 031

Hall By Exit 10 H/S √ √ A

Hall By Exit 10- South Hall M (10) √ √ 3 129

Room 15 Storage RHT √ √ 3

Hall By Room 15- SE Hall S √ √ 3 027

Hall By Room 15 H/S √ √ B

Health Room RHT √ √ 3
Health Room Storage RHT √ √ 3
Room 16 Storage RHT √ √ 3
Custodian Room RHT √ √ 3
Hall By Custodian Room- SE Hall S √ √ 3 023

Hall By Room 17 H/S √ √

Room 17 Storage RHT √ √ 3

Hall By Storage S √ √ 3 022

Storage RHT √ √ 3
Room 18 Storage RHT √ √ 3
Hall By Room 18- SE Hall S √ √ 3 019

Hall By Room 18 H/S √ √

Hall By Room 19- SE Hall S √ √ 3 018

Room 19 Storage RHT √ √ 3

Room 105 RHT √ √ 4
Hall By Room 105 (107) S √ √ 4 012

Storage By 146 RHT √ √ 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima Page 6 of 6

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 146- Daycare Room # 2 S √ √ 4 007

Room 146 H/S √ √ B

Room 146 Exit- Daycare Room # 2 M √ √ 4 127

Hall By Washroom- Corr 107 S √ √ 4 011

Hall By Washroom H/S √ √ B

Hall By Room 147 H/S √ √ A
Room 147- Daycare Room # 1 S √ √ 4 014

By Exit 11- Daycare Foyer S √ √ 4 015

By Exit 11- Daycare Foyer M (11) √ √ 4 004

Chapel DS √ √ 1 0040

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 27th, 2016

Address: 545 Baldoon Road, Chatham Building Name: Our Lady of Fatima

LOCATION MODEL # BATTERY RH # A B C D REMARKS

Principal's Office (102) SLC12200 (2) PA-6V12 (14) 2 13.60 10:50 525 Ok
Paper Storage by Chapel (Rm. 142) SLC12200 (2) NP7-12 (13) 2 13.68 10:55 480 Ok

Board Office
By Room 158 SLC12200 (2) PA-12V7.2 (08) 2 12.85 11:00 300 Ok
Storage Room 156 SLC12200 (2) NP7-12 (14) 2 13.00 11:00 297 Ok
Storage Room 123 RG 72 PA-6V12 (10) 2 13.95 11:05 280 Ok
Daycare Entrance SLC12200 (2) NP7-12 (14) 2 6.65 11:05 300 Ok
Boiler Room Exit (Room 150) 8 LMC Combo CSB 6V4.5 (11) 2 6.60 11:05 295 Ok

RH# - Remote Head

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a
complete building audit of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the
authority having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: Our Lady of Fatima

Address: 545 Baldoon Street Inspector: T.Neves

City/Prov: Chatham Date: July 22, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:

a) Are the hydrant(s) free from obstructions and accessible? YES

b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:

a) Was a flow test done? YES

b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply

3. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? No (Slow)
h) Was a flow test done? YES
i) The static pressure was? 55
j) The pitot reading from an engineered playpipe was 37 Using an outlet size of 2.5
k) The USGPM results are? 1021

545 Baldoon Street wo#21428 July 2016 Insp.xls 1

4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #6 have been completed.

7. The following items are recommendations only.

NONE

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

545 Baldoon Street wo#21428 July 2016 Insp.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 27th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
OUR LADY OF FATIMA~ 545 BALDOON ROAD, CHATHAM

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: July 27th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 25th, 2016

Building Name: St. Agnes

Address: 55 Croyden Street, Chatham

Security/Fire Alarm Panel [Make / Model]: Mircom FA-102

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ______________________

CFAA #: 19-996582 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883331 Gators
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification Mircom FA-102

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Breaker in Room 1094 off of Room 109

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 26.68
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 25.56
system in supervisory condition Current (A) 80.00
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 25.20
system in full load condition Current (A) 480.00
The charging current is Current (mA) 240
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test; √

(iv) A battery capacity meter test; or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 7
Record the battery terminal voltage after tests are completed. VDC 25.60

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 2.16
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders (x 3) √

Tie to Security √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: St. Agnes Address: 55 Croyden Street, Chatham Page 1 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Staff Room RHT √ √ 1

Conference Room RHT √ √ 1

Principal’s Office RHT √ √ 1

Secretary’s Office RHT √ √ 1

Hall By Office M √ √ 1

Electrical Room HT √ √ 1 Elec. Test

Sink Room HT √ √ 1 Elec. Test

Hall By Room 107 B √ √ NAC-1

Hall By Room 4 M √ √ 1

Boiler Room HT √ √ 1 Elec. Test

Boiler Room Exit M √ √ 1

Custodian Room RHT √ √ 1

By Room 118 B √ √ NAC-1

Storage off Boy's Washroom HT √ √ 1 Elec. Test

Workroom RHT √ √ 1

By Room 117 B √ √ NAC-1

East Exit M √ √ 1

Media Centre- Front RHT √ √ 1

Media Centre- Centre RHT √ √ 1

Media Centre- Rear RHT √ √ 1 High- Ladder

Media Centre B √ √ NAC-1

Media Centre Office 1/Conference RHT √ √ 1

Resource Centre HT √ √ 1 Elec. Test

Hall By Resource Centre DH √ √ (Door Holders)

Hall By Change Rm M √ √ 1

Hall By Change Rm M √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: St. Agnes Address: 55 Croyden Street, Chatham Page 2 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Hall By Change Rm B √ √ NAC-1

Lawnmower Storage HT √ √ 1 Elec. Test

Infirmary RHT √ √ 1

Boys Change Room RHT √ √ 1

Boys Change Room RHT √ √ 1

Girls Change Room RHT √ √ 1

Hall By Gym S (C2W BA) √ √ 1

NW Gym Ceiling HT √ √ 2 High (Visual)

NE Gym Ceiling HT √ √ 2 High (Visual)

SE Gym Ceiling HT √ √ 2 High (Visual)

SW Gym Ceiling HT √ √ 2 High (Visual)

Gym NW B √ √ NAC-1

Gym SE B √ √ NAC-1

Gym Exit Out M √ √ 2

Exit By Stage M √ √ 2

Stage HT √ √ 2 High (Visual)

Gym Storage HT √ √ 2 High (Visual)

Under Gym Stage L RHT √ √ 2 Caged

Under Gym Stage R RHT √ √ 2 Caged

Above Ceiling @ FACP AUX √ √ NAC-1

Hall By Rm 107 DH √ √

Entrance to Gym Rm 122 DH √ √

Hall By Media 119 S (C2W BA) √ √ 2

Hall By Media 121 S (C2W BA) √ √ 2

Hall By Media 107 S (C2W BA) √ √ 1
Hall By Media 109 S (C2W BA) √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 25th, 2016

Building Name: St. Agnes Address: 55 Croyden Street, Chatham

LOCATION MODEL # BATTERY RH# A B C D REMARKS

By Room 103 RGC 442 MT PA-6V7.2 (11) 2 7.02 8:56

By Room 115 RGC 442 MT PA-6V7.2 (12) 2 6.96 8:54

Computer Room West RGC 442 MT PA-6V7.2 (15) 2 6.96 8:59

Computer Room South COM 36 NP 5-12 (10) 4 14.02 8:58

Resource Office RGC 44 PA-6V12 (14) 2 6.90 9:02

Hall By Gym RG 36 PA-6V12 (10) 3 3.50 9:04 X See Repairs List

Gym Exit To Hall CLT VRW 36 PA 6V4.5 (09) 2 6.80 9:06 X See Repairs List
Gym Left CLT VRW 36 PA-6V4.5 (13 ) 2 3.50 9:08 X See Repairs List
Gym Right CLT VRW 36 PA-6V4.5 (13 ) 2 6.89 9:10

Stage Left COM 36 (2) PA-6V4.5 (12) 2 14.00 9:12

Stage Right COM 36 NP5-12 (13) 2 14.10 9:14

Boy’s Change Room Front RG 36 UB670 (14) 2 6.80 9:18

Boy’s Change Room Rear COM 36 (2) PA-6V4.5 (13) 2 11.00 9:16 X See Repairs List
Girl’s Change Room Rear COM 36 (2) NP5-12 (15) 2 14.20 9:20

Infirmary RGC 442 MT PA-6V4.5 (14) 2 6.90 9:22

Panel E in Gym Stage CC + 1 + 3

Gym Exit, Left & Right
A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Requires Service, Repairs, Missing
D- Repairs Completed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
1 Hall By Gym RG 36 Replaced Battery w/ (1) Panasonic PA-6V12 07/25/2016
2 Gym Exit To Hall CLT VRW 36 Replaced Battery w/ (1) Panasonic PA-6V4.5 07/25/2016
3 Gym Left CLT VRW 36 Replaced Battery w/ (1) Panasonic PA-6V4.5 07/25/2016
4 Boy’s Change Room Rear COM 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 07/25/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 25th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. AGNES, 55 CROYDON STREET, CHATHAM
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Albin Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Albin Berisha DATED: July 25th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 19th, 2016

Building Name: St. Anne

Address: 183 Snow Avenue, Blenheim

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs completed during inspection.

I A copy of this report has been given to: St. Clair Catholic District School Board

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was
left in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for
examination by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ___________________________

CFAA #: 19-996382 CFAA #: _________________________

Signature: ________________________ Signature: ________________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as
detailed in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name: Damar- System # 883332- Stars
Phone Number: (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Room 115A

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.52
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.6
in supervisory condition Current (A) 0.24
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.13
in full load condition Current (A) 1.52
The charging current is Current (mA) 0.72

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 26.40

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 6.52
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders √

Fan Shutdown √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 1 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Daycare
Electrical Exit M √ √ 5

Electrical HT √ √ 5 Elect. Tested

Kitchen HT-R √ √ 5

Kitchen B √ √ 5-1

Coat Room S (1400A) √ √ 5

Half Day- Front S (6249C) √ √ 5

Half Day- Rear S (C2M PDI) √ √ 5

Half Day Washroom RHT √ √ 5

Half Day Storage RHT √ √ 5

Office S (C2M PDI) √ √ 5

Front Door M √ √ 5

Coat Room S (6249C) √ √ 5

Coat Room M √ √ 5

Full Day (Rear) S (C2M PDI) √ √ 5

Full Day (Front) S (6249C) √ √ 5

Full Day Storage RHT √ √ 5

Full Day Exit M √ √ 5

Full Day W/C #1 RHT √ √ 5

Half Day B √ √ S-2

Full Day B √ √ S-1

Full Day W/C #2 RHT √ √ 5

School
Exit By Mechanical Room # 133 M √ √ 4

Hall By Mechanical Room # 133 B √ √ S-2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 2 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Hall By Room 136 S (1400A) √ √ 4

Mechanical Room 134 HT √ √ 4 Elect. Tested

Storage Room 132 RHT √ √ 4

Hall By Storage Room 132 S (6249C) X 4 See Repairs List

Hall By Classroom 130 S (C2M PDI) √ √ 4

Hall By Classroom 130 B √ √ S-2

Classroom 140 RHT √ √ 4

Classroom 140 S (C2M PDI) √ √ 4

Classroom 140 M √ √ 4

Classroom 140 W/C RHT √ √ 4

Classroom 140A Storage RHT √ √ 4

Mechanical Room HT √ √ 4 Elect. Tested

Janitors Room HT √ √ 4 Elect. Tested

Classroom 135 RHT √ √ 4 EOL

Hall By Classroom 142 S (1400 A) √ √ 4

Hall By Classroom 142 B √ √ S-1

Classroom 142 RHT √ √ 4

Classroom 142 M √ √ 4

Classroom 142 S (C2M PDI) √ √ 4

Classroom 142 Storage RHT √ √ 4

Class 142 W/C RHT √ √ 4

Girl’s W/C 131 RHT √ √ 4

Boy’s W/C 129 RHT √ √ 4

Hall By Boy’s W/C Room 129 B √ √ S-1

Storage Room 127 RHT √ √ 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 3 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Storage Room 127A HT √ √ 4 Elect. Tested

Storage Room 127A Exit Out M √ √ 4

Classroom 122 RHT √ √ 4

Classroom 125 RHT √ √ 4

Hall By Classroom 125 S (C2M PDI) √ √ 4

Hall By Classroom 125 (Doors) S (C2M PDI) √ √ 4

Hall By Classroom 120 B √ √ S-2

Hall By Classroom 120 S (6249C) √ √ 3

Classroom 7 RHT √ √ 3

Classroom 6 RHT √ √ 3

Hall By Room 118 S (6249C) √ √ 3

Photography Room 118 RHT √ √ 3

Chapel Room 121 RHT √ √ 3

Handicapped W/C 116 RHT √ √ 3

Chapel Workroom 119 RHT √ √ 3

Library A Rm 101 RHT √ √ 3 High

Library A Rm 101 B √ √ S-1

Library A Rm 101 M √ √ 3

Library B Rm 101 RHT √ √ 3 High

Library B Rm 101 B √ √ S-2

Library B Rm 101 M √ √ 3

Library Work Room 103 RHT √ √ 3

Women’s W/C In Library Workroom 103B RHT √ √ 3

Men’s W/C In Library Workroom 103A RHT √ √ 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 4 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Lobby S (6249C) √ √ 3 High

Lobby M √ √ 3

Staff Room 114 RHT √ √ 3

Staff Room 114 B √ √ S-2

Staff Storage 114A RHT √ √ 3

Office Rm 100 RHT √ √ 3

V.P. Office Rm 100B RHT √ √ 3

Principal’s Office Rm 100A RHT √ √ 3

Hall By Work Rm 103 B √ √ S-1

Class 102 RHT √ √ 3

Storage Room 105 RHT √ √ 3

Mechanical Room 105A M √ √ 3 Elect. Tested

Mechanical Room 105A HT √ √ 3

Hall By Class 102 S (C2M PDI) √ √ 3

Class 107 RHT √ √ 3

Hall By Class 107 S (C2M PDI) √ √ 3

Hall By Class 107 B √ √ S-2

Hall By Class 109 S (C2M PDI) √ √ 2

Hall By Class 109 S (6249C) √ √ 2

Class 109 RHT √ √ 2

Hall By Class 109 B √ √ S-1

Class 104 RHT √ √ 2

Class 104 Stage Stairs RHT √ √ 1

Boy’s W/C 111 RHT √ √ 2

Girl’s W/C 113 RHT √ √ 2

By Gym Exit Outside M √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 5 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

By Gym Exit Outside S (6249C) √ √ 2 High

Change Room 106C RHT √ √ 2

Change Room 106D HT (res) √ √ 2

Gym Storage 106B RHT √ √ 1

Gym RHT √ √ 1

Gym RHT √ √ 1

Gym RHT √ √ 1

Gym RHT √ √ 1

Gym Stage HT √ √ 1 Elect. Tested

Gym Stage HT √ √ 1

Gym Stage HT √ √ 1 Elect. Tested

Gym Storage 106A RHT √ √ 1

Gym Exit By 106A M √ √ 1

Gym By Time Clock M √ √ 1

Gym East B √ √ S-1

Gym 106B B √ √ S-2

Exit By Change Rm M √ √ 1 EOL

Class 108 RHT √ √ 2

By Class 108 B √ √ S-2 EOL

Mechanical Room 115 HT √ √ 2 Elect. Tested

Electrical Room 115A HT √ √ 2 Elect. Tested

Storage Room 110 RHT √ √ 2

Receiving Room 110A HT √ √ 2 Elect. Tested

Receiving Room 110A M √ √ 2

Class 117 RHT √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 6 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Hall By Class 117 S (6249C) √ √ 2

Class 112 RHT √ √ 2

Exit By Class 112 M √ √ 2

Hall By Class 117 B √ √ S-1 Elect. Tested

Class 6 Hall (2) Door Holders √ √

Class 10 Hall (2) Door Holders √ √

Hall By Classroom S (1400A) √ √ 4

Hall By Classroom 144 B √ √ S-1

In Classroom 144 RHT √ √ 4

Classroom 144 S (1400A) √ √ 4
Classroom 144 W/C RHT √ √ 4
Classroom 144 Storage RHT √ √ 4
Classroom 144 Exit M √ √ 4
Classroom 139 RHT √ √ 4
Hall by Classroom 139 S (1400A) √ √ 4
Hall by Classroom 146 B √ √ S-1

Classroom 146 RHT √ √ 4

Classroom 146 S (1400A) √ √ 4
Classroom 146 W/C RHT √ √ 4
Classroom 146 Storage RHT √ √ 4
Classroom 146 Exit M √ √ 4
Exit By 146 M √ √ 4
Class 139 RHT √ √ 4

Room 124 RHT √ √ 4

Room 124 HT √ √ 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim Page 7 of 7

LOCATION DEVICE A B C D E F SENS. REPAIRS

Classroom 146 W/C RHT √ √ 4
Classroom 146 Storage RHT √ √ 4
Classroom 146 Exit M √ √ 4
Exit By 146 M √ √ 4
Class 139 RHT √ √ 4

Room 124 RHT √ √ 4

Room 124 HT √ √ 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 19th, 2016

Building Name: St. Anne Address: 183 Snow Ave, Blenheim

LOCATION MODEL # BATTERY # A B C D REMARKS

Hall By Room 139 12ESL72/2M (2) PA-6V12 (14) 6 13.39 9:38 0.68
Mechanical Room 133A RG 12S360 PA-1233 (15) 6 13.39 9:40 1.03
Mechanical Room 134 RG 12S360 NP33-12 (14) 6 5.00 9:42 1.04 X See Repairs List
Hall By Mechanical Room 136 12ESL72/2M (2) PA-6V7.2 (14) 2 13.47 9:44 1.01
Storage By Room 127A RG 12S360 PA-1233 (12) 8 13.22 9:46 0.98
Mech. Storage 105A Unit #4 RG 12S360 PA-1233 (12) 6 13.43 9:48 1.07
Mech. Storage 105A Unit #5 RG 12S360 PA-1233 (12) 6 13.49 9:50 1.01
Electrical Room 115A Unit #6 RG 12S360 NP33-12 (15) 6 11.63 9:52 1.02 X See Repairs List
Electrical Room 115A Unit #7 RG 12S360 PA-1233 (12) 6 13.69 9:54 0.98
Gym Storage 106B RG 12S360 PA-1233 (12) 10 13.44 9:56 1.03
Gym Storage 106A RG 12S360 NP33-12 (15) 7 13.75 9:58 1.00

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm
1 Hall By Storage Room 132 S (6249C) Replaced Smoke w/(1) C2W-BA Detector 08/19/2016

Emergency Lighting
1 Mechanical Room 134 RG 12S360 Replaced Battery w/ (1) Enersys NP33-12 08/19/2016
2 Electrical Room 115A Unit #6 RG 12S360 Replaced Battery w/ (1) Enersys NP33-12 08/19/2016

Hydrant Inspection
Repairs not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St. Anne

Address: 183 Snow Ave. Inspector: T.Neves
City/Prov: Blenheim Date: July 22, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:

a) Are the hydrant(s) free from obstructions and accessible? YES

b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:

a) Was a flow test done? YES

b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply

3. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
i) The static pressure was? 65
j) The pitot reading from an engineered playpipe was 14 Using an outlet size of 2.5
k) The USGPM results are? 581

183 Snow Ave wo#21428 July 2016 Insp.xls 1

4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #6 have been completed.

7. The following items are recommendations only.

NONE

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.
As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

183 Snow Ave wo#21428 July 2016 Insp.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 19th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. ANNE~ 183 SNOW AVENUE, BLENHEIM

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: August 19th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 20th, 2016

Building Name: St. Anne

Address: 1000 The Rapids Parkway, Sarnia

Security/Fire Alarm Panel [Make / Model]: Notifier System 5000

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs not Required

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: _____________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre √
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114653 Gators
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Electrical Room

Control unit or transponder identification Notifier System 5000

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room
Circuit breaker or disconnect means location Electrical Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP12-12
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 27.50
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 25.20
system in supervisory condition Current (A) 0.364
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 24.90
system in full load condition Current (A) 1.508
The charging current is Current (mA) 2150
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 26.40

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 9.50 Ah
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification FCV Systems

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Fans √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: St. Anne Address: 1000 Rapids Parkway, Sarnia Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

201A DS (1451A) √ √ 10 EOL

201A DS (1451A) √ √ 10
201A DS (1451A) √ √ 10 EOL

201A M √ √ 8 EOL

201A RHT √ √ 8
201A H √ √ S-2
Stairs By 201A S (1451A) √ √ 9 EOL

Room 150A M √ √ 1
Exit By 147A M √ √ 1
By 146A H √ √ S-2
133 M √ √ 5
133 Electricial Room S (1451A) √ √ 5 EOL

By 146A S (2451A) √ √ 1
By 134 S (2451A) √ √ 1
By 134 V √ √ S-2
By 135 H √ √ S-2
Gym Exit M √ √ 1
Gym East Wall H √ √ S-2
Gym By 146B H √ √ S-2
Exit By 136 M √ √ 1
Room 137B RHT √ √ 7
Room 137B M √ √ 7
By 123 S (2451A) √ √ 2
In 123A H √ √ S-2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: St. Anne Address: 1000 Rapids Parkway, Sarnia Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

By 122A H √ √ S-1
By 122A V √ √ S-1
By 122A S (2451A) √ √ 2
Exit By 117 M √ √ 2
By 117 S (2451A) √ √ 2
By 115 H √ √ S-1
By 131C S (2451A) √ √ 2

By D04 H √ √ S-1
By D02B H √ √ S-1
D01A M √ √ 4
Exit By D02B S (1400A) √ √ 4

By D11 H √ √ S-1
By D02C S (1400A) √ √ 4

By D02D M √ √ 4
By 112A H √ √ S-1
By 108 S (2451A) √ √ 2
By 108 V √ √ S-1

By 109C H √ √ S-1
By 125 S (2451A) √ √ 2

By 104 V √ √ S-1
In 104 H √ √ S-1
By Front Door M √ √ 2
By Front Door S (2451A) √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: St. Anne Address: 1000 Rapids Parkway, Sarnia Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 157 RHT √ √ 6
By 159B S (2451A) √ √ 1
By 159A H √ √ S-2
By 157A V √ √ S-2
By 160 S (2451A) √ √ 1
Exit By 156B M √ √ 1 EOL
By 154A H √ √ S-2
Lobby By 154A S (2451A) √ √ 2
In 124 H √ √ S-1 EOL
In 124 H √ √ S-1
By 152A H √ √ S-2 EOL
By 152A V √ √ S-2
Lobby By 152A S (2451A) √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM- SPRINKLER
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: St. Anne Address: 1000 Rapids Parkway, Sarnia Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Sprinkler Flow Switch # 1 F/S √ √ 11
Sprinkler Flow Switch # 2 F/S √ √ 12
Sprinkler Flow Switch # 3 F/S √ √ 13
Sprinkler Flow Switch # 4 F/S √ √ 14

Sprinkler Flow Switch # 5 F/S √ √ 15

Sprinkler Flow Switch # 6 Main F/S √ √ 16

Monitor SV #1 SV √ 23 √

Monitor SV #2 SV √ 24 √

Monitor SV #3 SV √ 25 √

Monitor SV #4 SV √ 26 √

Monitor SV #5 SV √ 27 √

Monitor SV #6 SV √ 28 √

Sprinkler Low Pressure LP √ 30 √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: St. Anne Address: 1000 Rapids Parkway, Sarnia

LOCATION MODEL# BATTERY # A B C D REMARKS

151 Electrical RG 12S 360 PA-1233 (12) 13 13.65 9:11 1.048 Ok
148A Gym Storage RG 12S 360 PA-1233 (11) 7 13.75 9:11 1.010 Ok
148B Gym Storage RG 12S 360 PA-1233 (14) 7 13.45 9:11 1.000 Ok
115 Sink Room RG 12S 360 PA-1233 (11) 10 14.01 9:13 .999 Ok
DO5 RG 12S 360 PA-1233 (14) 11 13.65 9:14 1.015 Ok
157 Sprinkler RG 12S 360 PA-1233 (09) 12 13.57 9:11 1.021 Ok

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charge Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

We were required to return and test the remaining smokes as they had been covered by a contractor during renovations

Emergency Lighting
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St.Annes

Building Occupancy Type: Institutional Hazard: Light

Address: 1000 Rapids Parkway Inspector: T.Neves
City/Province: Sarnia Date: July 6, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #16

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is building completely sprinklered? YES
f) Are all new additions and renovations properly protected? N/A
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? N/A
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? Supervised

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? YES

b) The static pressure was? 70psi
c) The residual pressure was? 66psi
d) Type of water supply? CITY

1000 Rapids Parkway wo#21428 July 2016 Insp.xls 1

 4. TANKS, PUMPS & SIAMESE:

a) Are siamese connections in good condition, couplings free, caps in place and ball drips open? YES

5. FIRE HYDRANTS:

N/A

6. WET SYSTEMS:

# of wet systems: 1 Make & Model: Globe H-3 Alarm Valve

a) Are alarm valves in good condition? YES

b) Are flow switches working and in good condition? YES
c) Are tamper switches working and in good condition? YES
d) Is the excess pressure pump functional? YES
e) Is the valve trimmed properly? YES
f) The operation of the excess pressure pump is? AUTO
g)The excess pressure pump automatically starts at? 89psi
h)The excess pressure pump automatically stops at? 121psi

7. DRY SYSTEMS:

N/A

8. ANTI-FREEZE SYSTEMS:

N/A

9. SPECIAL SYSTEMS:

N/A

10. STANDPIPE SYSTEMS:

N/A

11. ALARMS:

a) Did the water motor gong test satisfactorily? YES

b) Did the electric alarm test satisfactorily? YES
c) Did the supervisory alarms test satisfactorily? YES
d) The low pressure switch sends a low pressure warning at? 77psi

1000 Rapids Parkway wo#21428 July 2016 Insp.xls 2

 12. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? YES
b) Are the sprinklers less than 50 years old? (1996) YES
c) Are there spare sprinklers and a wrench in the head cabinet? No
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? YES
e) Have the sprinklers been checked for the proper temperature rating? YES

13. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Sprinkler Room Alarm Valve Sprinkler Good
Main Control Valve Sprinkler Good
Low Pressure Switch (PS120) Sprinkler Good
Flow Pressure Switch (PS10) Sprinkler Good
Butterfly Control Valve Zone 1 Good
Flow Switch Zone 1 Good
Butterfly Control Valve Zone 2 Good
Flow Switch Zone 2 Good
Butterfly Control Valve Zone 3 Good
Flow Switch Zone 3 Good
Butterfly Control Valve Zone 4 Good
Flow Switch Zone 4 Good
Butterfly Control Valve Zone 5 Good
Flow Switch Zone 5 Good

14. Listed are recent changes in the building occupancy or fire protection equipment.

NONE

15. The following are corrections made at the time of inspection.

NONE

16. DEFICIENT ITEMS:

NONE

1000 Rapids Parkway wo#21428 July 2016 Insp.xls 3

 The above items are deficient as per The Ontario Fire Code and need to be corrected immediately.
A certificate of inspection cannot be issued until all items under section #16 have been addressed.
Consultation with the local fire prevention office is suggested, if discrepancies occur

17. The following items are recommendations only.

NONE

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item, component or
system in the building. Further, it is mutually agreed that the maximum amount of joint and several liability the
INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of warrantee, negligent
hiring, or any other theory of liability including violation of a statute or consumer protection act is strictly limited
to the FEE PAID for the inspection report.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify
that the sprinkler system installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report
would be required to certify this).

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the local
Fire Prevention office

1000 Rapids Parkway wo#21428 July 2016 Insp.xls 4

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 20th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. ANNE- 1000 THE RAPIDS PARKWAY, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE SPRINKLER SYSTEM HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN ULC
CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Not Required DATED: August 19th, 2016
CFAA #:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 8th, 2016

Building Name: St. Elizabeth

Address: 1350 Bertha St, Wallaceburg

Security/Fire Alarm Panel [Make / Model]: FA-1008KA

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs not Required

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-92091 CFAA #: _____________________

Signature: __________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm (Different Zone) √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Sys # 883 333- Chargers Name Damar
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

√

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room # 101

Control unit or transponder identification Mircom FA-1000

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room # 101
Circuit breaker or disconnect means location Room # 102

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number NP7-12
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 27.20
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in supervisory condition Current (A) 0.200
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.80
in full load condition Current (A) 1.39
The charging current is Current (mA) 398
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 25.80

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 6.70
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification Mircom

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication
link (DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders √

Tie to Security √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: St. Elizabeth Address: 1350 Bertha Street, Wallaceburg Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit By Room 116 M √ √ 1
Room 116 RHT √ √ 1

By East Exit (116) S (1400A) √ √ 1

Room 115 RHT √ √ 1
Hall By 115 B √ √ S-1

Room 114 RHT √ √ 1

By Room 114 S (1400A) √ √ 1
Room 113 RHT √ √ 1
Door Holders DH √ √ -
East of Library at Hall Doors S (1400A) √ √ 1
Hall By Library B √ √ S-1
East of Library S (1400A) √ √ 1
Library Left 112 RHT √ √ 1
Library Right 112 RHT √ √ 1
By Emergency Lighting (112) S (1400A) √ √ 1
By Room (112) S (1400A) √ √ 1
Gym Stage RHT √ √ 1 High

Gym Exit M √ √ 1
Gym B √ √ S-1 EOL

Gym Storage RHT √ √ 1 EOL

By Gym Entrance (111) S (1400A) √ √ 1

Hall By Gym B √ √ S-2
Girls Washroom B √ √ S-2
Boys Washroom B √ √ S-2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: St. Elizabeth Address: 1350 Bertha Street, Wallaceburg Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall at 109 M √ √ 1
By 109 S (C2M PD1) √ √ 1
Paper Storage Room 110 RHT √ √ 1
Book Storage Off of Room 110 A RHT √ √ 1
By 108 S (1400A) √ √ 1

Hall By Class 106 B √ √ S-1

By Room 106 S (1400A) √ √ 1
Boiler Room 101 M √ √ 1
Boiler Room 101 Front HT √ √ 1 Elec. Tested

Boiler Room 101 Back HT √ √ 1 Elec. Tested

By Boiler Room 101 S (1400A) √ √ 1

Electrical Room 102 RHT √ √ 1
Sink Room 102A RHT √ √ 1
Lobby M √ √ 1
By Lobby S (1400A) √ √ 2
Room 117 M √ √ 1

Room 117 B √ √ S-2

By Room 121 S (1400A) √ √ 2

By West Doors (123) S (1400A) √ √ 2

Room 123 M √ √ 1
Room 123 B √ √ S-2
Hall By Class 123 B √ √ S-1
By Room 125 S (1400A) √ √ 2
By Kitchen Room 125 B √ √ S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: St. Elizabeth Address: 1350 Bertha Street, Wallaceburg Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By Room 130 S (1400A) √ √ 2
By Centre Office Room 131 B √ √ S-1
Exit By Centre Office Room 131 M √ √ 2
Kitchen Room 125 RHT √ √ 2
By Room 126 S (1400A) √ √ 2
By Room 127 S (1400A) √ √ 2
Room 128 RHT √ √ 2
By Room 122 S (1400A) √ √ 2
By 122 B √ √ S-1
By Room 122 Front Left S (1400A) √ √ 2 High

By Room 122 Front Right S (1400A) √ √ 2 High

By Room 122 Back Right S (1400A) √ √ 2 High

Exit By Room 122 M √ √ 2 EOL

By Room 124 Front Left S (1400A) √ √ 2 High

By Room 124 Front Right S (1400A) √ √ 2 High

By Room 124 Back Left S (1400A) √ √ 2 High

By Room 130 S (1400A) √ √ 2

Room 134A RHT √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 8th, 2016

Building Name: St. Elizabeth Address: 1350 Bertha Street, Wallaceburg

LOCATION MODEL # BATTERY # A B C D REMARKS

By East Exit RG 36 PA-6V7.2 (12) 2 6.79 9:50 N/A Ok
Over Lockers RG 36 PA-6V7.2 (12) 2 6.81 9:53 N/A Ok
By Library # 6 RGC442MT9W PA-6V7.2 (13) 4 6.93 9:55 N/A Ok
In Gym RG 36 PA-6V12 (13) 3 6.95 10:00 N/A Panel G. Cct 25. Ok
Custodial Storage RG 36 PA-6V7.2 2 6.89 10:10 N/A Ok
Front Entrance RG 36 LMC PA-6V12 (12) 2 6.914 10:12 N/A Ok
West End- Best Start SLC12250 NP33-12 (14) 12 13.30 10:23 N/A Ok
Room 117 8LMCE2MT9W CSB-6V4.5 (13) 2 6.93 10:19 N/A Ok
Room 123 8LMCE2MT9W CSB-6V4.5 (13) 2 6.88 10:17 N/A Ok
By Library 7 RGC442MT9W PA-6V7.2 (14) 3 6.89 9:57 N/A Ok
Room 104 (Barrier Free W/C) RGC442MT9W PA-6V7.2 (14) 4 6.95 10:05 N/A Ok

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm
Repairs Not Required

Emergency Lighting
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. ELIZABETH~ 1350 BERTHA STREET, WALLACEBURG
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Not Required DATED: August 8th, 2016
CFAA #: ~~~~~~~~~~~~~~
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 9th, 2016

Building Name: Sacred Heart

Address: 434 St. John Street, Port Lambton

Security/Fire Alarm Panel [Make / Model]: Edwards Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed as of August 18th, 2016

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: _______________________

CFAA #: 19-995199 CFAA #: ______________________

Signature: _______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures
√
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures
√
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)]
√
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
√
transmits a trouble to the fire signal receiving centre
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883330 (Gaels)
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room 108A- Closet

Control unit or transponder identification Edwards EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 108 Closet
Circuit breaker or disconnect means location Room 108 Closet

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Enersys (2) NP12-12
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 27.17
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.82
in supervisory condition Current (A) 0.336
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.66
in full load condition Current (A) 1.788
The charging current is Current (mA) 420
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 27.02

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 8.96
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Entrance By 116
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble) √

Door Holders √

Fan Shutdown √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 434 John Street, Port Lambton Building Name: Sacred Heart Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Portapak By 115 M √ √ 2
Portapak By 115 H/S √ √

Portapak By 115 S (C2M PDI) √ √ 2 5

Room 115 H √ √

Room 115 RHT √ √ 2

By Room 118 S (C2M PDI) √ √ 2 5
By Room 118 RHT √ √ 2

By Room 118 H √ √

Portapak Entrance E M √ √ 2
Portapak Entrance W M √ √ 2
Portapak Entrance E S (C2M PDI) √ √ 2 5
Portapak Entrance W S (C2M PDI) √ √ 2 6
By Portapak Entrance S (C2M PDI) √ √ 1 5
By Portapak Entrance H/S √ √

By Portapak Entrance DS √ √ 3
Room 116 H √ √

By 116 M √ √ 1

By 116 S (C2M PDI) √ √ 1 5

Room 114 (Mechanical) HT (Res) √ √ 1
Room 114 (Mechanical) H √ √

By 116 EOL √ √ 2

By 116 EOL √ √ 3
By 116 EOL √ √ 1

Room 113 H √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.46 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Sacred Heart Address: 434 John Street, Port Lambton Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 110 Boy's Washroom H/S √ √

By 110 Boy's Washroom S (C2M PDI) √ √ 1 5

Room 108 RHT √ √ 1
Room 108 H √ √

Room 108 H √ √

Hall By 108 DS √ √ 3
By 108A S (C2M PDI) √ √ 1 5
By 108A S (C2M PDI) √ √ 1 5
By 108A H/S √ √

Room 108A H √ √

Room 108A RHT √ √ 1

By 106 S (C2M PDI) √ √ 1 5
Room 106 M √ √ 1

Room 106 H √ √

Room 106 RHT √ √ 1

Room 106A RHT √ √ 1

Room 109 M √ √ 1
Room 109 H √ √

Room 109 RHT √ √ 1

Room 107 RHT √ √ 1
Room 107A RHT √ √ 1
Room 104 RHT √ √ 1
By Room 104 S (C2M PDI) √ √ 1 5
Staff Room 105 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.46 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Building Name: Sacred Heart Address: 434 John Street, Port Lambton Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Staff Room 105 H √ √

Room 103 RHT √ √ 1

Room 102 RHT √ √ 1

By Room 100 S (C2M PDI) √ √ 1 5

By Room 100 M √ √ 1
Room 120 RHT √ √ 1
By 122 H/S √ √

Room 124 HT √ √ 1 Elec. Test

Room 124 H √ √

By 124 S (C2M PDI) √ √ 1 5

Room 101 RHT √ √ 1
By 101 M √ √ 1

Room 126 Kitchen HT X 1 Elec. Test See Repairs List

128 Gym H/S √ √

128 Gym H/S √ √

128 Gym M √ √ 1
128 Gym M √ √ 1
128 Gym RHT √ √ 1
128 Gym RHT √ √ 1

Room 128A RHT √ √ 1

Room 128A H √ √

Room 128B RHT √ √ 1

Room 128B H √ √

Room 128C RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.46 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 9th, 2016

Address: 434 John Street, Port Lambton Building Name: Sacred Heart

LOCATION MODEL # BATTERY # RH A B C D REMARKS

Mechanical Room # 114 SLD 24 720 (2) Standard 12V33 (08) 12 26.28 8:54 1139 Ok
Room 124 Furnace Room SLD 24 720 (2) Standard 12V33 (08) 16 26.39 8:48 1281 X See Repairs List
Gym Storage- Room 128C SLD 24 720 (2) Standard 12V33 (13) 12 26.62 8:52 1409 Ok

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charge Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Room 126 Kitchen HT Replaced Device w/ (1) C2W BA Heat Detector 08/09/2016

Emergency Lighting
1 Room 124 Furnace Room SLD 24 720 Replaced w/ (2) EnerSys NP33-12 Batteries 08/18/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 9th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
SACRED HEART~ 434 JOHN STREET, PORT LAMBTON
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Kevin Bury DATED: August 18th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 20th, 2016

Building Name: Sacred Heart, Sarnia

Address: 1411 LeCaron Avenue, Sarnia

Security/Fire Alarm Panel [Make / Model]: Simplex 4100A

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing of
D Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G √
H Comments:

* Repairs Not Required

I A copy of this report has been given to: SCCDSB- Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ___________________________

CFAA #: 19-992091 CFAA #: _________________________

Signature: _________________________ Signature: ________________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name Damar Syst. # 114652 49ers
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification Mircom FA-300

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Electrical Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number NP12-12
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.90
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.00
in supervisory condition Current (A) 0.371
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.90
in full load condition Current (A) 1.388
The charging current is Current (mA) 388
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 25.90

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 9.61
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders √

Tie to Security √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: Sacred Heart Address: 1411 LeCaron Ave., Sarnia Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

South Entrance (Exit # 1) M √ √ 2 M2-42

By Exit # 1 519A S √ √ 2 M2-40

NAC-
By Room 520 H/S √ √
1
By 518-A S √ √ 2 M2-39

By Exit # 2 SW By Kindergarden S √ √ 2 M2-38

By Exit # 2 SW By Kindergarden M √ √ 2 M2-37

Room 521-S Storage RHT √ √ 2 M2-36

NAC-
By 522 H/S √ √
1
By 522 S √ √ 2 M2-35
NAC-
By 523 H/S √ √
2
By 516-A Staff Room RHT √ √ 2 M2-33

By 523 S √ √ 2 2M-34
NAC-
By 524-A H/S √ √
1
By 515-A S √ √ 2 M2-31

By 515-A RHT √ √ 2 M2-32

By 525-A S √ √ 2 M2-30
NAC-
By 525-A H/S √ √
2
513 RHT √ √ 2 M2-29

By 501-A S √ √ 3 M2-44
NAC-
By 514-A H/S √ √
1
By Electrical Room S √ √ 3 M2-47

Electrical Room RHT √ √ 3 M2-45

Electrical Room RHT √ √ 3 M2-46

Room 511-P RHT √ √ 3 M2-48

NAC-
By 511-P H/S √ √
2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: Sacred Heart Address: 1411 LeCaron Ave., Sarnia Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 502-A S √ √ 3 M2-49

By 504 RHT √ √ 3 M2-50

NAC-
By 510-A H/S √ √
1
By 510-A S √ √ 3 M2-51
Room 509-A RHT √ √ 3 M2-53
By Exit 3 M √ √ 3 M2-52
By 508 H/S √ √ NAC-2

By 508 S √ √ 3 M2-60

By 507-A RHT √ √ 3 M2-55

Room 506 RHT √ √ 3 M2-54

By 529-A (Office) S √ √ 2 M2-25

Rm 529-A RHT √ √ 2 M2-25

Room 527A RHT √ √ 1 M1-28

Rm 528-S RHT √ √ 2 M2-27

By Exit # 4 By 530 S √ √ 2 M2-24

By Exit # 4 By 530 M √ √ 1 M2-57

NAC-
By Exit # 4 H/S √ √
1
By 531 S √ √ 2 M2-23

Library West RHT √ √ 1 M2-20

Library East RHT √ √ 1 M2-19

In Library- Exit South M √ √ 1 M2-58

Rm 544 RHT √ √ 1 M2-18

NAC-
By 544 H/S √ √
1
By 533-A S √ √ 2 M2-21

By 532-A M √ √ 2 M2-22

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: Sacred Heart Address: 1411 LeCaron Ave., Sarnia Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By Double Door By 533-A (South of 544) S √ √ 1 M2-17
NAC-
By 534-A H/S √ √
2
In 534-A RHT √ √ 2 M2-16

By 535-P Library S √ √ 1 M2-12

AHU
Rm 535 DS √ √ 104 M2-14

Rm 535 HT √ √ 1 M2-13

Girls Dressing Rm 536-A Corr To Gym S √ √ 1 M2-11

NAC-
By 542-A H/S √ √ EOL
1
By Rm 542 Music Rm S √ √ 1 M2-10

Rm 546-A RHT √ √ 1 M2-8

NAC-
By 541-A H/S √ √ EOL
2
By 541-A S √ √ 1 M2-9

By Exit # 5 NE Entrance M √ √ 1 M2-5

Rm 550 RHT √ √ 1 M2-1

By 540 Corr to Gym S √ √ 1 M2-6

Rm 539-A/ South Storage RHT √ √ 1 M2-2

549-A off Change Rm. RHT √ √ 1 M2-7

548-A off of Gym RHT √ √ 1 M2-4

NAC-
Gym H/S √ √
1
Gym Exit # 6 North M √ √ 1 M2-59

539-A North Storage RHT √ √ 1 M2-3

AHU
By 514-A (By Fountain) DS √ √ 102 M2-43 (Remote LED)
AHU
Hall By 521-S DS √ √ 101 M2-42 (Remote LED)
AHU
Gym Storage 534-A DS √ √ 103 M2015

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th, 2016

Building Name: Sacred Heart Address: 1411 LeCaron Ave., Sarnia

LOCATION MODEL # BATTERY RH # A B C D REMARKS

By Storage Rm By Kindergarten SLC12160-2N09T (2) 6V12 (13) 10 13.64 2:15 .633 Ok
By Office 529-A SLC12160-2N09T (2) 6V12 (13) 14 13.59 2:18 .971 Ok
By Room 518-A SLC12160 (2) 6V12 (11) 8 13.71 2:20 .840 Ok
By Gym Entrance SLA12050 (2) 6V4.5 (14) 4 14.10 2:22 .751 Ok
Gym Exit SPEXX10361 (2) 6V4.5 (14) 2 13.71 2:23 .861 Ok
Library 6 ESL 144 (2) PA-6V12 (11) 2 13:84 2:25 .911 Ok

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 20th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
SACRED HEART, 1411 CARON AVENUE, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: July 20th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 26th, 2016

Building Name: St. Joseph

Address: 25-35 Raleigh Street, Chatham

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ______________________

CFAA #: 19-996582 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883335 Crusaders
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification Edwards 6616

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Panel G in Basement Electrical Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number NP12-12
Battery manufacturer's date code or ins service date Date 2015
Battery Voltage (main power supply 'ON') is Voltage 26.28
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.50
in supervisory condition Current (A) 0.300
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.33
in full load condition Current (A) 0.920
The charging current is Current (mA) 810
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test; √

(iv) A battery capacity meter test; or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 12
Record the battery terminal voltage after tests are completed. VDC 25.60

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 7.66
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders (x 3) √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 26th, 2016

Building Name: St. Joseph Address: 25 Raleigh Street, Chatham Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

2nd Floor
Above Tile By Rm 5 By Locker 98 DS (6264C) √ √ 6
Above Tile By Locker 142 DS (6264C) √ √ 7
Above Tile By Locker 83 DS (6264C) √ √ 5

Above Tile By Locker 116 DS (6264C) √ √ 8

Hall By Staff Room S (C2M PDI) √ √ 14 5
Hall By Room 7 S (C2W BA) √ √ 14 4
Hall By Room 6 S (C2M PDI) √ √ 14 6
Top Of North Stairs S (C2W PDI) √ √ 3 5 EOL

1st Floor
Electrical Room Back Stair S (C2M PDI) √ √ 15 5
Hall By Room 4 S (C2M PDI) √ √ 13 5 EOL

Hall by Room 1 S (C2M PDI) √ √ 13 5

Hall By Principal’s Office S (C2M PDI) √ √ 13 6
Hall By Secretary S (C2M PDI) √ √ 13 4
Hal l By Girl’s C/R S (C2M PDI) √ √ 13 5
Hall By Gym Exit Outside S (C2M PDI) √ √ 13 5
Hall By East Exit S (C2M PDI) √ √ 13 6

2nd Floor
Health Rm French Office RHT √ √ 1
Hall By Staff Room M √ √ 1
Staff Lounge- Kitchen RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 6264C
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 26th, 2016

Building Name: St. Joseph Address: 25 Raleigh Street, Chatham Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Staff Lounge RHT √ √ 1
Staff Lounge Closet RHT √ √ 1
Janitors Room HT √ √ 1
Storage Fan Room RHT √ √ 1
Hall By Room 7 B √ √ NAC-1

Hall By Room 6 M √ √ 1

Top Of South Stairs S (C2W BA) √ √ 2 5

1st Floor
Hall By Room 4 M √ √ 1
Hall By Room 1 B √ √ NAC-1

Janitors Closet HT √ √ 1
Principal’s Office RHT √ √ 1
Office RHT √ √ 1
Office Closet RHT √ √ 1
Hall By Front Entrance M √ √ 1
Gym Exit To Hall M √ √ 1
Gym Exit M √ √ 1
Servery off Gym RHT √ √ 1
Gym Exit Hall M √ √ 1
Gym Storage RHT √ √ 1
Gym Stage RHT √ √ 1 High

Gym Right RHT √ √ 1 High

Gym Left RHT √ √ 1 High

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 26th, 2016

Building Name: St. Joseph Address: 25 Raleigh Street, Chatham Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym B √ √ NAC-1

Gym B √ √ NAC-1

Near Panel B √ √ NAC-1

Hall To Gym M √ √ 1
Room Across from Locker 35 RHT √ √ 1
Hall To Rm 9 Coat Room RHT √ √ 1
Room 9 RHT √ √ 1
Room 9 Right RHT √ √ 1

Hall By Room 9 M √ √ 1 EOL

Library Office RHT √ √ 1

Library Right RHT √ √ 1
Library Left RHT √ √ 1
Hall By Room 9 B √ √ NAC-1

Basement Stairs RHT √ √ 1

Basement Right RHT √ √ 1
Basement Left RHT √ √ 1
Under Stairs RHT √ √ 1
Basement Exit M √ √ 1
Basement B √ √ NAC-1

Basement By Electrical Room RHT √ √ 1

Electrical Room Right HT √ √ 1
Electrical Room Left HT √ √ 1
Custodian Room RHT √ √ 1
Electrical Room Exit M √ √ 1
Beside Stairs M √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 26th, 2016

Building Name: St. Joseph Address: 25 Raleigh Street, Chatham Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Store Room in Basement HT √ √ 1 Elect. Tested

Stairwell Doors Door Holders √ √

Main Exit Doors Door Holders √ √

Hall @ Girls W/C Door Holders √ √

Under Stage RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 26th, 2016

Building Name: St. Joseph Address: 25 Raleigh Street, Chatham

LOCATION MODEL # BATTERY RH# A B C D REMARKS

By Room 204 (2nd Floor) RG 36 PA-6V12 (14) 3 7.01 8:30

By Room 106 RG 36 PA-6V12 (13) 3 7.05 8:32

Gym Exit To Hall RG 36 LMC PA-6V7.2 (14) 2 6.95 8:34

Gym SE Exit To Hall RG 36 LMC PA-6V7.2 (08) 2 3.00 8:36 X √ See Repairs List
Gym NE Exit RG 36 LMC PA-6V12 (10) 2 7.00 8:38 X √ See Repairs List
Hall By Gym RG 36 4 PA-6V12 (14 2 6.92 8:40

Basement By Stair RG 36A PA-6V12 (10) 2 6.81 8:42 X √ See Repairs List
Basement Custodian Room RG 36 PA-6V7.2 (12) 2 7.09 8:44

Electrical Room # 1 RG 36 PA-6V7.2 (12) 2 7.15 8:46

Electrical Room # 2 RG 36 PA-6V7.2 (12) 2 6.97 8:48

Top Of Back Stairs RG 36 LMC PA-6V7.2 (11) 2 8.86 8:50

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
1 Gym SE Exit To Hall RG 36 LMC Replaced Battery w/ (1) Panasonic PA-6V7.2 07/26/2016
2 Gym NE Exit RG 36 LMC Replaced Battery w/ (1) Panasonic PA-6V7.2 07/26/2016
3 Basement By Stair RG 36A Replaced Battery w/ (1) Panasonic PA-6V12 07/26/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete
building audit of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the
authority having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 26th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. JOSEPH~ 25-35 RALEIGH ST. CHATHAM

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAS ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 26th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 21st, 2016

Building Name: St. Josephs

Address: 535 Birchbank Drive, Corunna

Security/Fire Alarm Panel [Make / Model]: Edwards ESA 2000

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing of
D Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs completed during inspection

I A copy of this report has been given to: Paul Lernout - SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: _______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114657 Saints
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room 140A off of Room 140

Control unit or transponder identification Edwards ESA 2000

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 140A off of Room 140
Circuit breaker or disconnect means location Room 140 Panel L Cct # 34

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) BB EP28-12
Battery manufacturer's date code or ins service date Date 2011
Battery Voltage (main power supply 'ON') is Voltage 27.00
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in supervisory condition Current (A) 0.650
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.90
in full load condition Current (A) 0.992
The charging current is Current (mA) 1820

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 25.60

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 16.1 Ah.
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification Edwards

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Door Holders √

Tie to Security √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 21st, 2016

Building Name: St. Joseph Address: 535 Birchbank Drive Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 751-A M √ √ 2
NAC-
860 H √ √ 1

860 S (1400A) √ √ 1
Exit Door 860 M X 1 See Repairs List
NAC-
By 743 H √ √ 1

By 744 M √ √ 2
741 RHT √ √ 3 EOL
NAC-
By 736 H √ √ 1

Exit Door 730 (Library) M √ √ 4

NAC-
730 H √ √ 1

By Front Door M √ √ 4
NAC-
By 705 H √ √ 1

705 S (C2M PDI) √ √ 5

705 By Door (6266-C) Duct Smoke (6266) √ √ 10
Back of 705 (6266-C) Duct Smoke (6266) √ √ 10
706 S (1400A) √ √ 6
Exit Off 709 M X 7 See Repairs List
NAC-
Exit Off 709 H √ √ 1

Coat Room Off 709 S (C2M PDI) √ √ 7 EOL

Coat Room Off 709 M √ √ 7

Exit Door Off 713 M √ √ 7
NAC-
Exit Door Off 713 H √ √ 1
NAC-
By 723 H √ √ 2

Exit By 723 M √ √ 7

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning 2451A 1.2-2.8 (Solo Trutest)
C- Alarm Operation Confirmed 6250A 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address C2M PDI 4-7 Blinks (Magnet)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 6249C 0.6-1.8 (Solo Trutest)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 21st, 2016

Building Name: St. Joseph Address: 535 Birchbank Drive Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Boys Change Rm 729 S (C2M PDI) √ √ 7 6
NAC-
Boys Change Rm 729 H √ √ 2

Stage RHT √ √ 8
NAC-
Back Stage Wall H √ √ 2

Stage Mech Room HT √ √ 8 Elect. Test

Stage Mech Room M √ √ 8

NAC-
Gym Right Side H √ √ 2

Gym Right Side M X 14 See Repairs List

NAC-
Gym Left Side H √ √ 2

Gym Left Side M √ √ 14

Gym Under Stage L S (C2W BA) √ √ 13
Gym Under Stage R S (C2W BA) √ √ 13
Hall By 721 M √ √ 7
Room 725 Girls S (C2M PDI) √ √ 7
NAC-
By Room 725 Girls H √ √ 2

YMCA West Wing

West Exit M √ √ 1
West Exit S (1400A) √ √ 1
Southwest Room S (1400A) √ √ 1
Southwest Room S (1400A) √ √ 1
NAC-
Southwest Room H √ √
1
Northwest Room S (1400A) √ √ 1
Northwest Room S (1400A) √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning 2451A 1.2-2.8 (Solo Trutest)
C- Alarm Operation Confirmed 6250A 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address C2M PDI 4-7 Blinks (Magnet)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 6249C 0.6-1.8 (Solo Trutest)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 21st, 2016

Building Name: St. Joseph Address: 535 Birchbank Drive Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Daycare Hall East S (1400A) √ √ 1
Daycare Northeast Room S (1400A) √ √ 1
Daycare Northeast Room S (1400A) √ √ 1
NAC-
Daycare Northeast Room H √ √
1
NAC-
Dare Care Hall H 1

Sprinkler Room
East Zone FS √ √ 12 EOL

Automatic Check Valve SV 17 √ EOL

West Zone SV 15 √ EOL

West Zone FS √ √ 14 EOL

Low Pressure LP 18 √ EOL

Shut Off SV 16 √ EOL

Shut Off SV 16 √ EOL

East Zone SV 13 √ EOL

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning 2451A 1.2-2.8 (Solo Trutest)
C- Alarm Operation Confirmed 6250A 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address C2M PDI 4-7 Blinks (Magnet)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 6249C 0.6-1.8 (Solo Trutest)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 21st, 2016

Building Name: St. Joseph Address: 535 Birchbank Drive, Corunna

LOCATION MODEL # BATTERY # A B C D REMARKS

Storage (151) RG 12S 144 (2) PA-6V12 (13) 3 13.92 11:00 630

Gym (Storage) RG 12S 144 (2) PA-6V12 (14) 7 13.25 11:03 545 Panel H CCT#27

Ceiling (Kitchen) RG 12S 72 PA-12V7.2 (14) 3 13.20 11:05 671 Panel A Cir #3

Custodian Room RG 12S 72 (2) PA-6V7.2 (14) 3 13.21 11:07 691 Panel A Cir #3

W / C Ceiling Rm 142C RG 12S 72 (2) PA-6V7.2 (12) 3 13.19 11:20 621 Panel A Cir #3

Outside Rm 140 Elect. (In 705P) RG 36 (2) PA-6V7.2 (12) 3 13.92 11:21 591 Panel B CCT#13

Electrical Room 140A RG 12S 72 (1) PA-6V7.2 (10) 1 6.79 11:22 582 Panel B CCT#13

Library Office Ceiling RG 12S 72 (2) PA-6V7.2 (13) 4 N/A 11:24 N/A X Panel B CCT#13

736A Ceiling RG 12S 72 (2) PA-6V7.2 (14) 3 13.20 11:25 591 Panel B CCT#3

Custodian Room RG 12S 72 (2) PA-6V12 (14) 4 13.25 11:27 630 Panel D CCT #3

Storage RG 12S 100 (2) PA-6V7.2 (13) 3 13.20 11:29 633 Panel D CCT #3

83 Ceiling (860 First Rm on Left) RG 12S 100 (2) PA-6V7.2 (10) 4 13.34 11:30 692 Panel C CCT #1

YMCA Area- West Exit RG 442MTSW (1) PA-6V12 (14) 4 6.89 11:32 643 Panel T CCT #3

Panel A- Rm 723 A Storage Panel B- 705P Electrical Room Panel C- Rm 83

Panel D- Storage Rm 746A Panel H- Rm 723A Storage Panel T- Daycare Entrance

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Exit Door 860 M Replaced (1) Manual Pull Station Glass Rod 07/21/2016
2 Exit Off 709 M Replaced (1) Manual Pull Station Glass Rod 07/21/2016
3 Gym Right Side M Replaced (1) Manual Pull Station Glass Rod 07/21/2016

Emergency Lighting

1 Library Office Ceiling RG 12S 72 Replaced Batteries w/ (2) Panasonic PA-6V7.2 07/21/2016

Sprinkler System
Repairs not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St.Joseph's

Building Occupancy Type: Institutional Hazard: Light

Address: 535 Birchbark Street Inspector: T.Neves
City/Province: Corunna Date: July 8, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #16

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is building completely sprinklered? YES
f) Are all new additions and renovations properly protected? N/A
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? N/A
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? Supervised

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? YES

b) The static pressure was? 45psi
c) The residual pressure was? 32psi
d) Type of water supply? CITY

4. TANKS, PUMPS & SIAMESE:

a) Are siamese connections in good condition, couplings free, caps in place and ball drips open? YES
(Brass)

535 BirchBank wo#21428 July 2016 Insp.xls 1

 5. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
Hydrant # 1:
i) The static pressure was? 49
j) The pitot reading from an engineered playpipe was 33 Using an outlet size of 2.5
k) The USGPM results are? 964

6. WET SYSTEMS:

# of wet systems: 1 Make & Model: Gem Alarm Valve -F2001

a) Are alarm valves in good condition? YES

b) Are flow switches working and in good condition? YES
c) Are tamper switches working and in good condition? YES
d) Is the excess pressure pump functional? YES
e) Is the valve trimmed properly? YES
f) The operation of the excess pressure pump is? AUTO
g)The excess pressure pump automatically starts at? 110psi
h)The excess pressure pump automatically stops at? 124psi

7. DRY SYSTEMS:

N/A

8. ANTI-FREEZE SYSTEMS:

N/A

9. SPECIAL SYSTEMS:

N/A

10. STANDPIPE SYSTEMS:

N/A

11. ALARMS:

a) Did the water motor gong test satisfactorily? YES

b) Did the electric alarm test satisfactorily? YES
c) Did the supervisory alarms test satisfactorily? YES
d) The low pressure switch sends a low pressure warning at? 94psi

535 BirchBank wo#21428 July 2016 Insp.xls 2

 12. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? YES
b) Are the sprinklers less than 50 years old? (1995) YES
c) Are there spare sprinklers and a wrench in the head cabinet? YES
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? YES
e) Have the sprinklers been checked for the proper temperature rating? YES

13. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Storage Room Alarm Valve West/ East Sprinkler Good
Main Control Valve West Zone Good
Main Control Valve Tamper West Zone Good
Main Control Valve Alarm Valve Good
Main Control Valve Tamper Alarm Valve Good
Main Control Valve East Zone Good
Main Control Valve Tamper East Zone Good
PS120 Alarm Valve Good
Flow Switch West Zone Good
Flow Switch East Zone Good

14. Listed are recent changes in the building occupancy or fire protection equipment.

NONE

15. The following are corrections made at the time of inspection.

NONE

16. DEFICIENT ITEMS:

NONE

The above items are deficient as per The Ontario Fire Code and need to be corrected immediately.
A certificate of inspection cannot be issued until all items under section #16 have been addressed.
Consultation with the local fire prevention office is suggested, if discrepancies occur

17. The following items are recommendations only.

NONE

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify
that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report would be
required to certify this).

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

Notes:
West Zone Insp.Test in 751A (Ceiling)
East Zone Insp.Test in Gym (Chair Storage)

535 BirchBank wo#21428 July 2016 Insp.xls 3

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 21st, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. JOSEPH- 535 BIRCHBANK DRIVE, CORUNNA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE SPRINKLER SYSTEM & FIRE HYDRANT HAVE ALSO BEEN INSPECTED
AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: July 21st, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 24th, 2016

Building Name: St. John Fisher

Address: 44 Main Street, Forest

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs completed as of August 29th/2016

I A copy of this report has been given to: Paul Lernout - SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114656-Lakers
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

√

Termination points for wiring to field devices secure √

Control unit or transponder location Main Entrance

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Front Door
Circuit breaker or disconnect means location Room 151-P off 150-A

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.60
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.500
in supervisory condition Current (A) 0.340
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in full load condition Current (A) 1.201
The charging current is Current (mA) 770

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 25.80

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 8.87
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication
link (DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm & Trouble) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 24th, 2016

Building Name: St. John Fisher Address: 44 Main Street, Forest Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

In 102 Conference Room H √ √ 1

By 1008 Office Filing Room DS (ESD-2W) √ √ 3

Hall at 124 H √ √ S-3

By Room 101 S (C2M PDI) √ √ 2

By Room 102 S (C2M PDI) √ √ 2

In 101 S (C2M PDI) √ √ 2

In 101A RHT √ √ 2

In 101B Exit M √ √ 2

In 101B RHT √ √ 2

In 101B H √ √ 2

Hall at 103 H √ √ 2

In 103 RHT √ √ 2

103 Exit M √ √ 2

104 Custodial M √ √ 2

In 104 RHT √ √ 2 Elec Test

Hall at 106 S (C2M PDI) √ √ 2

In 105 RHT √ √ 2

In 108 Staff RHT √ √ 2

Hall at 110 S (C2M PDI) √ √ 2

In 110 RHT √ √ 2

In 107 Boys Washroom RHT X 2 See Repairs List

In 109 Girls Washroom RHT √ √ 2

Hall Exit at 109 M √ √ 2

Hall Exit at 109 S (C2M PDI) √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.56 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 24th, 2016

Building Name: St. John Fisher Address: 44 Main Street, Forest Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

In 111 RHT √ √ 2

Hall at 110 H √ √ 2

In 112 RHT √ √ 2

At 112C RHT √ √ 2

In 112 Exit M √ √ 2

112A RHT √ √ 2

112B RHT √ √ 2

112C RHT √ √ 2

112D RHT √ √ 1

Hall at 112 S (C2M PDI) √ √ 2 Relay For Doors

Hall at 114 S (C2M PDI) √ √ 1

Room 114 Kitchen RHT √ √ 1

Room 113 RHT √ √ 1

Room 113 H √ √ 1

Exit at 115 M √ √ 1

Exit at 115 S (C2M PDI) √ √ 1

In Room 114 DS √ √ 3

In 115 RHT √ √ 1

Hall at 117 S (C2M PDI) √ √ 1 Relay Door Holders

In 117 RHT √ √ 1

In 117 H √ √ S-1

116 Girls Washroom RHT √ √ 1

118 Boys Washroom RHT √ √ 1

In 119 Daycare 1 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.56 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 24th, 2016

Building Name: St. John Fisher Address: 44 Main Street, Forest Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

In 119 Daycare 1 H √ √ 1

In 121 Daycare 2 RHT √ √ 1

In 121 Daycare 2 H √ √ 1

Exit at 122 M √ √ 1

In 122 M √ √ 1

In 122 RHT √ √ 1

In 119 Daycare 1 S (C2M PDI) √ √ 1

In Room 122 H √ √ 1

In Room 124 ESV √ √ 10 EOL

Room 127 ESV √ √ 11

Room 127 FS √ √ 5

Room 127 TS √ √ 5

Hall at 100 Office S (C2M PDI) √ √ 2

Hall at 100 Office M √ √ 2

In 100 Office File Room RHT √ √ 2

In 127 Boiler Room A HT √ √ 2 Elec Test

Hall at 127 S (C2M PDI) √ √ 2

Room 129 Custodian RHT √ √ 2

Room 131 Library RHT √ √ 2

125 Boys Washroom RHT √ √ 2

123 Girls Washroom RHT √ √ 2

Hall at 133 H √ √ 2

By Room 133 S (C2M PDI) √ √ 2

Hall at 128 S (C2M PDI) √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.56 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 24th, 2016

Building Name: St. John Fisher Address: 44 Main Street, Forest Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

By 123 H √ √ S-4

Hall By Room 135 S (C2M PDI) √ √ 2

In Room 135 RHT √ √ 2

137 Kitchen HT √ √ 2

Exit at 137 M √ √ 2

Exit at 137 S (C2M PDI) √ √ 3

139 Gym Ceiling RHT √ √ 2 High

139 Center Ceiling RHT √ √ 2 High

139 at Exit Ceiling RHT √ √ 2 High

Gym Side Exit M √ √ 2

139A Gym RHT √ √ 2

139B Boys Change Room RHT √ √ 2 Cage

139C Girls Change Room RHT √ √ 2 Cage

139D RHT √ √ 2

139E RHT √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed ESD-2W 0.79-2.56 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 24th, 2016

Building Name: St. John Fisher Address: 44 Main Street, Forest

LOCATION MODEL # BATTERY #RH A B C D REMARKS

Room 135 SLD 24550 (2) PA-12V33 (12) 13 26.77 11:45 129

Room 101B Exit SLEX 6 36 PA-6V4.5 (14) 2 6.97 11:47 260

Room 104 SLD 24550 (2) PA-12V33 (09) 22 27.69 11:50 1310

Room 112D SLD 24550 (2) PA-12V33 (09) 10 - 11:52 - X See Repairs List

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 In 107 Boys Washroom RHT Replaced Device w/ (1) 5601A Heat Detector 08/24/2016
2 Edwards Fire Alarm Panel Edwards 6616 Replaced Batteries w/ (2) EnerSys NP33-12 08/29/2016

Emergency Lighting
1 Room 112D SLD 24 550 Replaced (1) 24 Volt PC Board 08/29/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 24th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. JOHN FISHER~ 44 MAIN STREET NORTH, FOREST
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: .HYLQ%XU\ CONFIRMED BY: Jim Anderson

CFAA #: 19-99
FA. REP'S TECH: Kevin Bury DATED: August 29th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: September 1st, 2016

Building Name: St. Joseph

Address: 43 St. Clair Street, Tilbury

Security/Fire Alarm Panel [Make / Model]: Edwards Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was
left in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for
examination by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre √
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883334 Black Knights
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices

Output circuit designations correctly identified in relation to connected field devices

Correct designations for common control functions and indicators

Plug-in components and modules securely in place

Plug-in cables securely in place

Cleanliness and free of dust and dirt

Record the date, revision and version of firmware:

Date: 08/22/2014 Revision: 02.50.00 Version:

Record the date, revision and version of the program software:

Date: 01/12/2009 Revision: Vol. 20.00 Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Main Entrance
Control unit or transponder location
EST Quickstart
Control unit or transponder identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Electrical Room 101, Panel DP.1 Brk. # 19

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Leoch 12V18
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 27.20
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.30
in supervisory condition Current (A) 0.325
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in full load condition Current (A) 2.20
The charging current is Current (mA) 900

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 18
Record the battery terminal voltage after tests are completed. VDC 26.80

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 8.90
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication
link (DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders (x 2) √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury Page 1 of 5

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit By 140 M √ √ 3

Hall By 140 S √ √ 3

Room 131 RHT √ √ 3

Storage Room 131 A RHT √ √ 3

Room 130 Office RHT √ √ 3

Hall Exit at 130 M √ √ 3

Handicap Washroom RHT √ √ 3

Hall at A RHT √ √ 3

Hall By 129 S √ √ 3

Hall By Room 138 H/S √ √ S-3

Room 129 A H √ √ 3

Hall By Room 126 S √ √ 3

Room 126 RHT √ √ 3

Hall at 124 H/S √ √ 3

Work Room 127 RHT √ √ 3

Storage Room 127 A RHT √ √ 3

Room 127 A Exit M √ √ 3

Storage Room 125 RHT √ √ 1

Hall By Room 124 M √ √ 1

Room Closet 124 A RHT √ √ 1

Room Office 124 B RHT √ √ 1

Room 123 RHT √ √ 1

Hall By 122 H/S √ √ S-4

Room 134 RHT √ √ 1

Room 122 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury Page 2 of 5

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 122 A RHT √ √ 1

Exit By Room 122 M √ √ 1

Janitor Room 120 RHT √ √ 1

Storage Room 119 RHT √ √ 1

Storage Room 117A RHT √ √ 1

Room Storage 118A RHT √ √ 1

Room Storage 119 A RHT √ √ 1

Room 113 A RHT √ √ 1

Room 114 A RHT √ √ 1

Hall By Storage Room 111 M √ √ 1

Storage Room 111 RHT √ √ 1

Room Storage 112 A RHT √ √ 1

Room Storage- Rm 105 A RHT √ √ 1

Chapel 110 RHT √ √ 1

Hall By Chapel H/S √ √ S-3

Room 107 HT (Res) √ √ 1

Principals Office 108 HT (Res) √ √ 1

Principals Closet RHT √ √ 1

V. Principal Office 106 HT (Res) √ √ 1

Room 105 A RHT √ √ 1

Electrical Room 101 RHT √ √ 1

Boiler Room 103 HT √ √ 1 Elec. Test

Boiler Room 100 H/S √ √ S-4

Exit By Boiler Room #5 M √ √ 1

Office Room 100 HT (Res) √ √ 1

Library 104 H/S √ √ S-4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury Page 3 of 5

LOCATION DEVICE A B C D E F SENS. REMARKS

Library 104 M √ √ 1

Kitchen 102 RHT √ √ 1

Main Entrance M √ √ 1

Room 133 B RHT √ √ 1

Staff Room Left 132 RHT √ √ 1

Staff Room Right 132 RHT √ √ 1

Staff Room Closet 132 A RHT X 1 See Repairs List

Slop Sink Room 135 RHT √ √ 1

Hall By 135 H/S √ √ S-2

Room 136 S √ √ 1

Room 139 A RHT √ √ 1

Hall By 136 M √ √ 1

Exit By Gym M √ √ 1

Hall By 137 H/S √ √ S-1

Room 138 RHT √ √ 1

Boys Change 139 RHT √ √ 1 Cage

Room 140B Storage S √ √ 1 Cage

Hall By 140 S √ √ 1 Siga D:006

Exit By 140 M √ √ 1

Stage Storage Left HT √ √ 1 Elec. Tested

Stage Storage Right HT √ √ 1 Elec. Tested

Gym Storage RHT √ √ 1

Gym H/S √ √ S-2

Gym Left Exit M √ √ 1

Gym Right Exit M √ √ 1

Under Stage RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury Page 4 of 5

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym Stage HT √ √ 1

Hall By Gym H/S √ √ S-1 EOL

By 124 H/S √ √ S-3

By 125 S √ √ 4 Siga D:009

By 123 S √ √ 4 Siga D:074

By 119 S √ √ 4 Siga D:005

By 121 S √ √ 4 Siga D:101

Room 122 H √ √ S-4 EOL

Room 118 H √ √ S-4 EOL

Room 117 H √ √ S-4

Room 112 H √ √ S-4

Room 109 H √ √ S-3

Room 105 H √ √ S-3
Library H/S √ √ S-3
Room 133 H √ √ S-3
Room 136 H √ √ S-2
Room 139 H √ √ S-2
By 117 S √ √ 4 Siga D:010

By 116 S √ √ 4 Siga D:003

By 114 S √ √ 4 Siga D:011

By 112 S √ √ 4 Siga D:007

By 107 S √ √ 4 Siga D:033

By 101 S √ √ 4 Siga D:034

By 133 S √ √ 4 Siga D:001

By 137 S √ √ 4 Siga D:012

Gym Hall Exit S √ √ 4 Siga D:002

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury Page 5 of 5

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 124 H √ √ S-3
Room 114 H √ √ S-4

Room 113 H √ √ S-3

Room 133 H √ √ S-2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: September 1st, 2016

Building Name: St. Joseph Address: 43 St. Clair Street, Tilbury

LOCATION MODEL # BATTERY # A B C D REMARKS

By Exit # 4 3LER4502MT9W PA-6V7.2 (15) 2 6.99 10:25 170
Hall By Room 140 RGC 442 MT 9W CGB 6V7 (08) 2 6.75 10:27 200 X See Repairs List
Hall By Room 129 RGC 442 MT 9W CGB 6V7 (08) 2 6.80 10:29 100 X See Repairs List
Hall by Room 132 NV12250/25RQW/AT (3) BB12-7 (14) 2 6.89 10:31 210
Hall by Room 125 Storage 3 LER PA-6V7.2 (15) 2 6.97 10:33 150
Hall by Room 122 3 LER CGB 6V7 (08) 2 6.87 10:35 160 X See Repairs List
Hall by Exit #3 3 LER CGB 6V7 (08) 2 6.76 10:37 165 X See Repairs List
Hall by Room 119 Storage RGC442 MT 9W CGB 6V7 (08) 2 6.77 10:39 171 X See Repairs List
Hall by 115 Boys WC RGC 442 MT 9W PA-6V7.2 (15) 2 6.95 10:41 190
Hall by Room 113 RGC 442 MT 9W CGB 6V7 (08) 2 6.82 10:43 150 X See Repairs List
Hall by 112 RGC 442 MT 9W PA-6V7.2 (14) 2 6.89 10:45 167
Hall by 107 Photocopy Rm RGC 442 MT 9W CGB 6V7 (08) 2 6.79 10:47 154 X See Repairs List
Hall by Exit #5 3 LER CGB 6V7 (08) 2 6.78 10:49 161 X See Repairs List
Mech Room # 103 3 LER E-WATT 6V7 (13) 2 6.93 10:51 179
Hall by 100 Office 3 LER CGB 6V7 (08) 2 6.75 10:53 181 X See Repairs List
Library Exit 3 LER CGB 6V7 (08) 2 6.81 10:55 179 X See Repairs List
Library Exit to Hall 3 LER CGB 6V7 (08) 2 6.80 10:57 158 X See Repairs List
Main Entrance 3 LER PA-6V7.2 (15) 2 6.99 10:59 210
Main Entrance RGC 442 MT 9W PA-6V7.2 (14) 2 6.90 11:00 144
Hall by Room 134 - Girls W/C RGC 442 MT 9W PA 6V7.2 (12) 2 6.87 11:02 161
Hall by Room 136 3 LER CGB 6V7 (08) 2 6.79 11:04 171 X See Repairs List
Hall at Exit # 6 3 LER CGB 6V7 (08) 2 6.69 11:06 183 X See Repairs List
Hall by Exit # 6 RGC 442 MT 9W CGB 6V7 (08) 2 6.71 11:09 175 X See Repairs List
Hall by Exit # 9 3 LER PA-6V7.2 (14) 2 6.83 11:11 198
Gym Exit to Hall 3 LER CGB 6V7 (08) 2 6.77 11:14 168 X See Repairs List
Gym NW Exit 3 LER CGB 6V7 (08) 2 6.76 11:16 166 X See Repairs List
Gym NE Exit 3 LER CGB 6V7 (08) 2 6.78 11:18 173 X See Repairs List

# Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Staff Room Closet 132 A RHT Replaced Device w/ (1) 5601A Heat Detector 09/01/2016

Emergency Lighting

1 Hall By Room 140 RGC 442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
2 Hall By Room 129 RGC 442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
3 Hall by Room 122 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
4 Hall by Exit #3 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
5 Hall by Room 119 Storage RGC442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
6 Hall by Room 113 RGC 442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
7 Hall by 107 Photocopy Rm RGC 442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
8 Hall by Exit #5 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
9 Hall by 100 Office 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
10 Library Exit 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
11 Library Exit to Hall 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
12 Hall by Room 136 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
13 Hall at Exit # 6 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
14 Hall by Exit # 6 RGC 442 MT 9W Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
15 Gym Exit to Hall 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
16 Gym NW Exit 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016
17 Gym NE Exit 3 LER Replaced Battery w/ (1) Panasonic PA-6V7.2 09/01/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: September 1st, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
SAINT JOSEPH, 43 ST. CLAIR STREET, TILBURY
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Kevin Bury DATED: September 1st, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 8th, 2016

Building Name: St. Matthews Catholic School

Address: 720 Elm Street, Sarnia

Security/Fire Alarm Panel [Make / Model]: Edwards EST Quickstart

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection &
D Testing of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs not Required

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was
left in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for
examination by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature:_______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114625 Meteors
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: 2010 Revision: 5 Version:

Record the date, revision and version of the program software: √

Date: 2010 Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room # 153

Control unit or transponder identification Edwards EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 153
Circuit breaker or disconnect means location Room 105A- DPI CCT 10

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator.
√

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number FACP - Enersys NP18-12B BPS- Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2013 2013
Battery Voltage (main power supply 'ON') is Voltage 27.20 26.40
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.60 25.70
supervisory condition Current (A) 0.296 0.048
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.30 24.40
full load condition Current (A) 0.44 3.143
The charging current is Current (mA) 471 597

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test; √

(iv) A battery capacity meter test; or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 17.2 7
Record the battery terminal voltage after tests are completed. VDC 27.00 26.50

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): FACP 7.33 / Booster 2.74
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: Both √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Main Entrance
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification Loop Class A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble, Supervisory) √

Fan Shutdown √

Door Holders √

Corridor Lighting Control √

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone 1.1 East School
Northwest Lobby S (Siga PS) √ √ 1.1 006

Above Chapel S (Siga PS) √ √ 1.1 007

Northeast Lobby S (Siga PS) √ √ 1.1 008

Southeast Lobby S (Siga PS) √ √ 1.1 009

Office South S (Siga PS) √ √ 1.1 010

Office North S (Siga PS) √ √ 1.1 011

Gym Lobby Southeast S (Siga PS) √ √ 1.1 012

Gym Lobby Southwest S (Siga PS) √ √ 1.1 013

Gym Lobby North S (Siga PS) √ √ 1.1 014

Hall By Room 108 S (Siga PS) √ √ 1.1 015

Hall By Room 112 S (Siga PS) √ √ 1.1 016

Hall By Room 114 S (Siga PS) √ √ 1.1 017

Hall By Room 116 S (Siga PS) √ √ 1.1 018

Hall By Room 118 S (Siga PS) √ √ 1.1 019

Hall By Girls Washroom Rm # 119 S (Siga PS) √ √ 1.1 020

Hall By Room 124 S (Siga PS) √ √ 1.1 021

Hall By Room 126 S (Siga PS) √ √ 1.1 022

Hall By Girls W/C West Rm #131 S (Siga PS) √ √ 1.1 024

Northeast Exit by Rm 120 M (270/SPO) √ √ 1.1 133

Main Entrance M (270/SPO) √ √ 1.1 136

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone 1.2 West
Hall By Daycare S (Siga PS) √ √ 1.2 001

Hall By Southwest Entrance S (Siga PS) √ √ 1.2 002

Hall By Library West S (Siga PS) √ √ 1.2 003

Hall By Library Centre S (Siga PS) √ √ 1.2 004

Hall By Library East S (Siga PS) √ √ 1.2 005

Hall By Room 132 S (Siga PS) √ √ 1.2 025

Hall By Room 134 S (Siga PS) √ √ 1.2 026

Hall By Room 140A S (Siga PS) √ √ 1.2 027

Room 140A Coat Room S (Siga PS) √ √ 1.2 028

Hall By Room 140B S (Siga PS) √ √ 1.2 029

Hall By Room 150A S (Siga PS) √ √ 1.2 030

Room 150 Coat Room S (Siga PS) √ √ 1.2 031

Hall By Room 150B S (Siga PS) √ √ 1.2 032

Daycare Entrance S (Siga PS) √ √ 1.2 034

Preschool Playroom S (Siga PS) √ √ 1.2 035

Daycare Cubbies S (Siga PS) √ √ 1.2 036

Storage Room 135 S (Siga PS) √ √ 1.2 042

Southwest Exit (Exit by Daycare) M (270/SPO) √ √ 1.2 127

Daycare West Exit M (270/SPO) √ √ 1.2 128

Room 150 Exit M (270/SPO) √ √ 1.2 129

Room 140 Exit M (270/SPO) √ √ 1.2 130

Northwest Exit By Room 130 M (270/SPO) √ √ 1.2 132

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone 1.3 Gym
IT Room S (Siga PS) √ √ 1.3 033

Multipurpose Room West S (Siga PS) √ √ 1.3 023

Zone 2.1- Penthouse

Top of Stair S (Siga PS) √ √ 2.1 037

Penthouse DS √ √ 2.1 047

Penthouse DS √ √ 2.1 048

Penthouse DS √ √ 2.1 049

Top of Stair M √ √ 2.1 150

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM- AUDIBLES
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 1 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall By 118 H/S √ √

Hall By 114 H/S √ √

Hall By 110 H/S √ √

Hall By 122 H/S √ √

Hall By 126 H/S √ √

Multipurpose West H/S √ √

Stage H/S √ √

Hall By Room 130 H/S √ √

Hall By Room 134 H/S √ √

Hall By Kindergarten H/S √ √

Kindergarten Room 140 H/S √ √

Kindergarten Room 140 Coat Rm H/S √ √

Hall By FACP H/S √ √

Kindergarten Room 150 H/S √ √

Kindergarten Room 150 Coat Rm H/S √ √

Hall By Daycare H/S √ √

Daycare Hall West H/S √ √

Daycare Hall East H/S √ √

Hall By Library West H/S √ √

Hall By Library East H/S √ √

Gym Lobby H/S √ √

Main Lobby H/S √ √

Library East H/S √ √

Library West H/S √ √

Office H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 2 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym East Wall H/S √ √

Gym North Wall H/S √ √

Gym West Wall H/S √ √

Gym South Wall H/S √ √

Penthouse West H/S √ √

Penthouse East H/S √ √

FACP EOL √ √ Signal

FACP EOL √ √ Signal

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone SV-1.3
Penthouse CT-1 √ 1.3 √ 145

Penthouse EOL √ 1.3 √

Penthouse SV √ 1.3 √

Zone SV-2.1

Penthouse CT-1 √ 2.1 √ 146

Penthouse EOL √ 2.1 √

Penthouse SV √ 2.1 √

Zone SV-3
Penthouse CT-1 √ 3 √ 147

Penthouse EOL √ 3 √

Penthouse SV √ 3 √

Zone FS 1.1
1st Floor Sprinkler Rm (105A) CT2 √ 1.1 √

East Wing Flow FS √ 1.1 √ 142

1st Floor Sprinkler Room EOL √ 1.1 √

Zone FS 1.2
1st Floor Sprinkler Rm (105A) CT2 √ 1.2 √

West Wing Flow FS √ 1.2 √ 141

1st Floor Sprinkler Room EOL √ 1.2 √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone SV 1
1st Floor Sprinkler Rm (105A) CT2 √ 1
Main Incoming #1 SV √ 1 √ 138

1st Floor Sprinkler Room EOL √ 1 √

Zone SV 2
1st Floor Sprinkler Rm (105A) CT2 √ 2
Main Incoming #3 SV √ 2 √ 137

1st Floor Sprinkler Room EOL √ 2 √

Zone SV 1.1
1st Floor Sprinkler Rm (105A) CT2 √ 1.1
East Wing SV √ 1.1 √ 139

1st Floor Sprinkler Room EOL √ 1.1 √

Zone SV 1.2
1st Floor Sprinkler Rm (105A) CT2 √ 1.2
West Wing SV √ 1.2 √ 140

1st Floor Sprinkler Room EOL √ 1.2 √

Zone FS 1.3
Penthouse CT2 √ 1.3
Penthouse FS √ √ 1.3 148

Penthouse EOL √ √ 1.3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthews Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Zone FS 2.1
Penthouse CT2 √ 2.1
Penthouse FS √ √ 2.1 149

Penthouse EOL √ √ 2.1

Isolators
In Storage 135 ISO √ 038

In Storage 135 ISO √ 041

In Stage Kitchen ISO √ 039

In Stage Kitchen ISO √ 040

Across Room 134 ISO √ 043

Across Room 134 ISO √ 044

In Sprinkler Room ISO √ 045

In Outdoor Storage ISO √ 046

In Penthouse ISO √ 050

In Penthouse ISO √ 051

Hall @ Room 126 ISO √ 052

Hall @ Room 126 ISO √ 053

Control Relays
Daycare Kitchen CR √ 126

Learning/Resource CR √ 134

Office CR √ 135

Stage Kithcen CR √ 131

In Penthouse CR √ 144

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 8th, 2016

Address: 720 Elm Avenue, Sarnia Building Name: St. Matthew

LOCATION MODEL # BATTERY RH # A B C REMARKS

Electrical- Room 105A RG12S250 (4) PA-6V12 (15) 19 13.47 12:13 EB-1 Panel A CCT 60

Stroller Storage- Room 157 RG12S250 (4) PA-6V12 (15) 15 13.75 12:12 EB-2 Panel B CCT 42

Room 125B- off Room 125 RG12S250 (4) PA-6V12 (15) 20 13.91 12:14 EB-3 Panel C CCT 60

Room 135 Storage RG12S250 (4) PA-6V12 (15) 20 13.81 12:15 EB-4 Panel D CCT 10

Custodian- Room 115 RG12S250 (4) PA-6V12 (15) 20 13.97 12:10 EB-5 Panel E CCT 10

Mechanical Room- 2nd Floor RG12S250 (4) PA-6V12 (15) 8 13.86 12:13 M4 Panel

Coat Room # 140, Exit # 14 5LER4502MT9W (2) PA-6V12 (15) 4 13.87 12:09
Coat Room # 150, Exit # 15 5LER4502MT9W (2) PA-6V12 (15) 4 13.89 12:11
Room 106 By W/C RG125250 (4) PA-6V12 (15) 8 13.92 12:13 EB-6 Panel A CCT 3

Panel A- Electrical Room 105A

Panel B- Day Care Hall
Panel C- Rm # 125
Panel D- Hall by Rm 135
Panel E- Rm 115
Panel M4- 2nd Floor

RH # - Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
Repairs Not Required

Sprinkler & Fire Hydrant

Repairs Not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Anderson's Electronic's Location: St.Mattews

Building Occupancy Type: Institutional Hazard: Light & Ordinary

Address: 720 Elm Ave Inspector: T.Neves
City/Province: Sarnia Ontario Date: July 8, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #15

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is the building completely sprinklered? YES
f) Are all areas accessed in the building properly protected? YES
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? YES
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? SUPERVISED
d) Did the electronic supervisory switches operate? YES

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? (1-1/4") YES

b) The static pressure was? 66
c) The residual pressure was? 52
d) Type of water supply? MUNICIPAL
e) Does the fire protection incoming water supply have a backflow preventor? YES
f) Has the backflow preventor been tested for cross contamination? NO

4. TANKS, PUMPS & SIAMESE:

a) Are siamese connections in good condition, couplings spin freely, caps in place and ball drips open? Yes
(Chrome)

720 Elm Ave wo#21428 July 2016 Insp.xls 1

5. FIRE HYDRANTS:

a) Was the hydrant road box valve found? YES

b) Does the hydrant road box valve appear to be open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? NO
h) Was a flow test done? YES

Hydrant # 1:
i) The static pressure was? 70
j) The pitot reading from an engineered playpipe was 39 Using an outlet size of 2.5
k) The USGPM results are? 1048

6. WET SYSTEMS:

# of wet systems: Make & Model: Valve & flow switches

a) Are alarm valves in good condition? N/A

b) Are the flow switches working and in good condition? YES
c) Did the water motor gong test satisfactorily? N/A
d) Are the low pressure switches working and in good condition? N/A
e) The low pressure switch operates at? N/A
f) Is the excess pressure pump functional? N/A
g) Is the valve trimmed properly? N/A
h) The operation of the excess pressure pump is? N/A
i) The excess pressure pump automatically starts at? N/A
j) The excess pressure pump automatically stops at? N/A

7. DRY SYSTEMS: N/A

8. ANTI-FREEZE SYSTEMS: N/A

9. SPECIAL SYSTEMS: N/A

10. STANDPIPE SYSTEMS: N/A

11. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? Yes
b) Are the sprinklers less than 50 years old? Yes
c) Are there spare sprinklers and a wrench in the head cabinet? Yes
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? Yes

e) Have the sprinklers been checked for the proper temperature rating in various locations where possible? Yes

720 Elm Ave wo#21428 July 2016 Insp.xls 2

12. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Rm 105A 4" BF Valve Backflow Incoming Operational
Rm 105A 4" BF Valve Backflow Discharge Operational
Rm 105A 4" Backflow Sprinkler System Operational
Rm 105A 2-1/2" B.Fly Valve East Sprinklers Operational
Rm 105A 2-1/2" Flow Switch East Sprinklers Operational
Rm 105A 3" B.Fly Valve West Sprinklers Operational
Rm 105A 3" Flow Switch West Sprinklers Operational
Stairwell 1.1 4" B.Fly Valve Main-Gym&Mech Rm Operational
Mech.Rm. 3" B.Fly Valve Mech. Rm. Sprinklers Operational
Mech.Rm. 3" Flow Switch Mech. Rm. Sprinklers Operational
Mech.Rm. 2-1/2" B.Fly Valve Gym Sprinklers Operational
Mech.Rm. 2-1/2" Flow Switch Gym Sprinklers Operational

13. LISTED ARE RECENT CHANGES IN THE BUILDING OCCUPANCY OR FIRE PROTECTION EQUIPMENT:

NONE

14. THE FOLLOWING ARE CORRECTIONS MADE AT THE TIME OF INSPECTION:

NONE

15. DEFICIENT ITEMS:

NONE

The above items are deficient as per The Ontario Fire Code and need to be corrected immediately. A certificate of inspection
cannot be issued until all items under section #15 have been addressed. Consultation with the local fire prevention office is
suggested, if discrepancies occur

16. THE FOLLOWING ITEMS ARE RECOMMENDATIONS ONLY:

NONE

17. FITTERS NOTES:

*Hydrants drain VERY slow.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify that the
sprinkler system installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report would be required to
certify this).

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT warranting or
guaranteeing the adequacy, performance or life expectancy of any structure, item, component or system in the building.
Further, it is mutually agreed that the maximum amount of joint and several liability the INSPECTOR can incur for any error,
mistakes, omissions, breach of contract, breach of warrantee, negligent hiring, or any other theory of liability including violation
of a statute or consumer protection act is strictly limited to the FEE PAID for the inspection report.

720 Elm Ave wo#21428 July 2016 Insp.xls 3

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 8th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
SAINT MATTHEWS CATHOLIC SCHOOL, 720 ELM STREET, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE SPRINKLER SYSTEM & FIRE HYDRANT HAVE ALSO BEEN INSPECTED
AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Kevin Bury DATED: July 8th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 16th, 2016

Building Name: St. Michael's

Address: 1930 Wildwood Drive, Bright's Grove

Security/Fire Alarm Panel [Make / Model]: Mircom FA-1000

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout @ SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by the
Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as
detailed in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name Damar- 114659 (Crusaders)
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Side Entrance

Control unit or transponder identification Mircom 1000

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Side Entrance
Circuit breaker or disconnect means location Boiler Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (4) Panasonic LCR0612
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.90
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.30
in supervisory condition Current (A) 0.170
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.00
in full load condition Current (A) 0.360
The charging current is Current (mA) 180

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 6
Record the battery terminal voltage after tests are completed. VDC 26.00

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 4.26
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm & Trouble) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 16th, 2016

Building Name: St. Michael's Address: 1930 Wildwood Drive, Brights Grove
Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

South Exit By FACP M √ √ 3

140 Storage HT √ √ 3 Elec. Tested

138 Electrical HT-R √ √ 3

Hall By Gym H √ √ S-1

Boys Changeroom Storage 139 RHT √ √ 3

Girls Changeroom Storage 125 RHT √ √ 3

Hall To Gym Storage 131 RHT √ √ 3

Room 129 RHT √ √ 3

Gym Front on Ceiling RHT √ √ 3 Cage

Gym Center RHT √ √ 3 Cage

Gym Rear RHT √ √ 3 Cage

Gym H √ √ S-1 Cage

Gym Exit Right - Door #9 M √ √ 3

Gym Exit Left M √ √ 3

Gym Storage Right- At Exit RHT √ √ 3

Gym Storage Left - At Kitchen RHT √ √ 3

932 Kitchen HT √ √ 2 Elect. Tested

931 Kitchen Storage/Maint. Supplies 123 RHT √ √ 2

134 Coat Room RHT √ √ 1

Coat Room Exit #7 M √ √ 1

Hall By 123 H √ √ S-2

Room 107 RHT √ √ 1

Janitor at 104 RHT √ √ 2

119 Off Library RHT √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.98-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Solo Trutest)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 2451A 0.98-2.1 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 16th, 2016

Building Name: St. Michael's Address: 1930 Wildwood Drive, Brights Grove
Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Library Front RHT √ √ 1

Library Rear RHT √ √ 1

Library Office 101A RHT √ √ 2

Hall By Staff Room H √ √ S-2

Staff Room Entrance 117 RHT √ √ 2

Staff Room 117C S (2451A) √ √ 2 RB

Staff Room Kitchen 117C RHT √ √ 2

Staff Room Rear 117D S (2451A) √ √ 4 RB

Staff Rear 117D Door # 6 M √ √ 4

Staff Room Door Holders √ √ AUX

Room 124B RHT √ √ 3

Room 124C RHT √ √ 2

Janitor Room 12E RHT √ √ 2 Elect. Tested

Storage Room 121 RHT √ √ 2

124 Exit # 9 M √ √ 2

Hall By 942A S (2451A) √ √ 2 Relay Door Holders

Exit By 947 M √ √ 6

Exit By 937 S (2451A) √ √ 6 Relay Door Holders

Exit By 947 H √ √ S-2

Room 100B RHT √ √ 1

Main Entrance- Exit #1 M √ √ 1

Secretary’s Office- 100 RHT √ √ 1

Hall @ 942 Door Holders √ √ AUX

100B at 100C Office Meeting Room RHT X See Repairs List

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.98-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Solo Trutest)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 2451A 0.98-2.1 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 16th, 2016

Building Name: St. Michael's Address: 1930 Wildwood Drive, Brights Grove
Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Principal - Room 100A RHT √ √ 1

142 Work Room RHT √ √ 1

Hall By Office H √ √ S-2

Room 122 @ Window RHT √ √ 1 Elec. Test

Room 122 RHT √ √ 1 Elec. Test

Hall By 117 H √ √ S-2

Hall By 112 S (1451A) √ √ 1 RB Door Relay

Hall By 116 Exit #7 M √ √ 1

Exit 3 at 116 H √ √ S-2

NW Exit at 114- Exit #2 M √ √ 5

NW Exit at 114 S (1451A) √ √ 5 RB

NW Exit Door Holders √ √ AUX

Room 122A- Math Room RHT √ √ 2

Hall at 118 M √ √ 2

Hall at 118 S √ √ 2 RB

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.98-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Solo Trutest)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed 2451A 0.98-2.1 (Mod 400)
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August , 2016

Building Name: St. Michael's Address: 1930 Wildwood Drive, Brights Grove

LOCATION MODEL # BATTERY # A B C D REMARKS

By 901 RG 36 A – 3 6V12 (15) 3 7.10 9:20 .401
By 908 RG 36 A – 4 PA-6V12 (10) 4 6.80 9:20 .550 X See Repairs List
By 911 RG 36 A – 2 PA-6V12 (15) 2 6.99 9:20 .450
By 913 RGC 44 2MT9W PA-6V12 (14) 2 6.87 9:20 .501
By 939 RG 36 A – 2 6V12 (14) 2 6.86 9:22 .310
By 940 RG 36 A – 3 6V12 (14) 3 6.93 9:22 .340
Off Room 944- Exit Out RG 36 LMC – 2 PA-6V7.2 (12) 2 6.81 9:22 .350
By 920 RG 36 A – 2 6V12 (14) 3 6.80 9:23 .550
In 925 (Boys Changeroom) RG 36 A – 3 PA-6V12 (14) 3 6.79 9:23 .500
In 929 off 927 (Girls Changeroom) RG 36 A – 3 PA-6V12 (09) 2 6.79 9:23 - X See Repairs List
By 926 (Gym Entrance) RG 36 A – 4 PA-6V12 (08) 4 6.82 9:23 - X See Repairs List
Gym Right by Exit 9 PXM 36 – 2 PA-6V7.2 (11) 2 6.86 9:23 - X See Repairs List
Gym Left PXM 36 – 2 PA-6V7.2 (15) 2 7.00 9:23 .550

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 100B at 100C Office Meeting RHT Replaced Device w/ (1) 5601A Heat Detector 08/16/2016

Emergency Lighting
1 By 908 RG 36 A – 4 Replaced Battery w/ (1) Panasonic PA-6V12 08/16/2016
2 In 929 off 927 (Girls Changeroom) RG 36 A – 3 Replaced Battery w/ (1) Panasonic PA-6V12 08/16/2016
3 By 926 (Gym Entrance) RG 36 A – 4 Replaced Battery w/ (1) Panasonic PA-6V12 08/16/2016
4 Gym Right by Exit 9 PXM 36 – 2 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/16/2016

Sprinkler and/or Hydrant Testing

Repairs not Required

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St. Michaels

Address: 1931 Wildwood Street Inspector: T.Neves
City/Prov: Bright's Grove Date: July 6, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:

a) Are the hydrant(s) free from obstructions and accessible? YES

b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:

a) Was a flow test done? YES

b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply

3. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
i) The static pressure was? 64
j) The pitot reading from an engineered playpipe was 36 Using an outlet size of 2.5
k) The USGPM results are? 1007

1931 Wildwood Street Brights Grove wo#21428 July 2016.xls 1

4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #6 have been completed.

7. The following items are recommendations only.

NONE

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

1931 Wildwood Street Brights Grove wo#21428 July 2016.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 16th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. MICHAEL, 1930 WILDWOOD DRIVE, BRIGHTS GROVE
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT AT THIS LOCATION WAS ALSO TESTED.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS COMPLETED IN ACCORDANCE WITH CANADIAN ULC
CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: August 16th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 16th, 2016

Building Name: St. Michaels Catholic School

Address: 25 Maple Street South, Ridgetown

Security/Fire Alarm Panel [Make / Model]: Siemens FS-250

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* Repairs completed as of August 29th, 2016

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883338 Cardinals
Phone Number (519) 351-0060
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Custodian Room # 42

Control unit or transponder identification Siemens

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Custodian Room # 42
Circuit breaker or disconnect means location Custodian Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number Panasonic LCR0612P
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 27.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in supervisory condition Current (A) 0.303
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 24.90
in full load condition Current (A) 0.834
The charging current is Current (mA) 1351

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity. AH 12
Record the battery terminal voltage after tests are completed. VDC 26.40

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 7.81
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification Siemens

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification Loop

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 29th, 2016

Building Name: St. Michael Address: 25 Maple Street South, Ridgetown Page 1 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit North by 14 M (#8) √ √ 1 1001

Hall by 14 B √ √ S-1
Hall by 14 S √ √ 2 1028

Room 14 RHT √ √ 3 1011

Room 14 B √ √ S-1
Room 22 (15) RHT √ √ 3 1010

Room 22 (15) B √ √ S-1

Hall @ Library Door Holders √ √

Hall @ Library S √ √ 2 1029

In Library RHT √ √ 3 1024

In Library B √ √ S-1
Library Office 58 RHT √ √ 3 1009

Library Storage 5 RHT √ √ 3 1047

Hall by Class 12 B √ √ S-1

In Class 12 B √ √ S-1
Class 12 Coat Room S √ √ 2 1030

Class 12 Coat Room Exit M √ √ 1 1008

Hall to Stage S √ √ 2 1031

Photocopy Room 14 RHT √ √ 3 1012

Photocopy Room 14 B √ √ S-1

Class 11 B √ √ S-1
Staff W/C RHT √ √ 3 1013

Hall by Class 11 S √ √ 2 1032

Hall at Resources (AC16) DS √ √ 7 1046

Hall at Girls Washroom (AC15) DS √ √ 6 1045

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 29th, 2016

Building Name: St. Michael Address: 25 Maple Street South, Ridgetown Page 2 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Custodian Room RHT √ √ 3 1019

Class Room 2 Storage RHT √ √ 3 1023

Hall to Gym (AC17) DS √ √ 8 1042

Kitchen @ Gym 18 RHT √ √ 3 1014

Gym B √ √ S-1
Stage 19 S √ √ 2 1033

Under Stage RHT √ √ 3 1034

Gym Storage 20 RHT √ √ 3 1015

Gym Exit @ Stage M (#6) √ √ 1 1002

Gym Exit South M (#5) √ √ 1 1003

Hall by Office B √ √ S-1

Hall by Office S √ √ 2 1036

Main Entrance M (#4) √ √ 1 1004

Hall Doors @ Office Door Holders √ √

Class 9 B √ √ S-1
Boys C/R Hall 17 S √ √ 2 1035

Boys C/R Hall 27 RHT √ √ 3 1016

By Girls W/C & Classroom 8 S √ √ 2 1037

Girls C/R 33 RHT √ √ 3 1017

Room 8 B √ √ S-1
Corridor @ 8 B √ √ S-1
Staff Room RHT √ √ 3 1027

Room 5 B √ √ S-1
Hall @ 5 S √ √ 2 1038

Hall @ 5 B √ √ S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 29th, 2016

Building Name: St. Michael Address: 25 Maple Street South, Ridgetown Page 3 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Daycare Rear Exit M (#3) √ √ 1 1005

Outside Storage Rear Boiler RHT √ √ 3 1021

Hall @ Exit By #6 S √ √ 2 1039

Class 6 B √ √ S-1
Nurse Room RHT √ √ 3 1048

Class 5 B √ √ S-1
Custodian Room 42 RHT √ √ 3 1018

Custodian Room 42 M (#2) √ √ 1 1006

Custodian Room 42 B √ √ S-1

Custodian Storage RHT √ √ 3 1020

Hall @ 4 B √ √ S-1
Resource Room 40 RHT √ √ 3 1023

Storage 44 RHT √ √ 3 1022

Hall @ 3 B √ √ S-1
Hall @ 3 S √ √ 2 1040

Class 4 B √ √ S-1
Class 3 B √ √ S-1
Supply Room RHT √ √ 3 1026

Class 2 B √ √ S-1
Hall @ 1 B √ √ S-1
Class 1 B √ √ S-1
Hall @ #1 S √ √ 2 1041

Exit @ #1 M (#1) √ √ 1 1007

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 29th, 2016

Building Name: St. Michael Address: 25 Maple Street South, Ridgetown Page 4 of 4

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall by Class 4 S √ √ 2 1048

Boys Changeroom AC02 DS √ √ 5 1043

Hall By Boys W/C AC01 DS √ √ 4 1044

Corridor 104 Courtyard Exit M √ √ 1 1051

Daycare Entrance M √ √ 1 1050

Daycare RHT √ √ 3 1049

Daycare B √ √ S-1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 29th, 2016

Building Name: St. Michael Address: 25 Maple Street South, Ridgetown

LOCATION MODEL # BATTERY # RH A B C D REMARKS

PortaPak Hall RG 36 PA-6V12 (11) 2 6.71 1:15 0.170 X See Repairs List
Hall By Stage JML 36 PA-6V12 (14) 3 6.91 1:20 0.280 Ok
Gym Entrance RG 36 PA-6V12 (13) 4 6.81 1:23 0.201 Ok
Hall By Office RG 36 PA-6V12 (12) 2 6.83 1:25 0.210 Ok
Hall By Nurses Office RG 36 (2) PA-6V7.2 (10) 2 6.70 1:27 0.160 X See Repairs List
Hall By Room 2 RG 36 PA-6V12 (12) 4 6.81 1:30 0.212 Ok

#- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Test Start Time
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs Not Required

Emergency Lighting
1 PortaPak Hall RG 36 Replaced Battery w/ (1) Panasonic PA-6V12 08/29/2016
2 Hall By Nurses Office RG 36 Replaced Batteries w/ (2) Panasonic PA-6V7.2 08/29/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 29th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. MICHAELS, 25 MAPLE ROAD SOUTH, RIDGETOWN
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: August 29th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 11th, 2016

Building Name: St. Peter Canisius

Address: 424 Victoria Street, Watford

Security/Fire Alarm Panel [Make / Model]: Simplex 4006

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm Systems √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs completed during inspection July 11th, 2016

I A copy of this report has been given to: SCCDSB- Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ___________________________

CFAA #: 19-996382 CFAA #: _________________________

Signature:______________________ Signature:______________________
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114661 Cougars
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: 2013 Revision: 1.03.03 Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location By Room 111

Control unit or transponder identification Simplex

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location By Room 111
Circuit breaker or disconnect means location Room 101

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) 12V7.2
Battery manufacturer's date code or ins service date Date 2013
Battery Voltage (main power supply 'ON') is Voltage 26.80
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.30
in supervisory condition Current (A) 0.130
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in full load condition Current (A) 0.490
The charging current is Current (mA) 1.20

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type. √
Record battery capacity . AH 7.2
Record the battery terminal voltage after tests are completed. VDC 25.48

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 24 x 0.13= 3.12 + 0.22 = 3.34
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location By Room 100
Annunciator or remote trouble signal unit identification Simplex

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations
Annunciator or sequential display identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations
Remote trouble signal unit identification

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location
Printer Identification

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location
Control Unit or Transponder Identification
Data Communication link identification

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble) √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Peter Canisius Address: 424 Victoria Street, Watford Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 127 (Daycare) M √ √ 1
In 127 RHT √ √ 1
By 127 M √ √ 1
By 127 S (C2M PDI) √ √ 1

By 127 H √ √ NAC-1

Hall By 121 S (1400A) √ √ 1

In 122 RHT √ √ 1
By 122 H √ √ NAC-1

Hall By 106 A S (1400A) √ √ 1

Gym Storage - Right HT √ √ 1 Elect. Tested

Gym Storage - Left RHT √ √ 1

Gym Exit M √ √ 1
Gym - 120 H √ √ NAC-1

Gym - 120 RHT √ √ 1

Gym - 120 RHT √ √ 1
By Gym S (1400A) √ √ 1
By 117 S (1400A) √ √ 1
By 117 H √ √ NAC-1

Hall Around Corner 118 M √ √ 1

Hall Around Corner 118 S (1400A) √ √ 2
Hall By 124 M √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 2451A 2.3-3.7 (Mod 400)
D- Annunciation Indication Confirmed 1400A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 4098-9601 1.0-3.6 (Tru-Test)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Peter Canisius Address: 424 Victoria Street, Watford Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Hall By 124 S (1400A) √ √ 2 RB

Exit By 129 M √ √ 2
Hall By 131 S (1400A) √ √ 2

Hall By 131 Buzzer √ √ NAC-1

Hall By 130 S (1400A) √ √ 2

Hall By 133 H √ √ 2
Storage 114 RHT √ √ 1
Storage 116 RHT √ √ 1

Boiler 110 HT √ √ 1 Elect. Tested

Boiler 108 HT √ √ 1 Elect. Tested

Hall By 115 S (1400A) √ √ 1

By 108 S (1400A) √ √ 1
By 107 M √ √ 1
By 105 S (C2W BA) √ √ 1
Room 109 HT √ √ 1 Elect. Tested

By 109 H √ √ NAC-1

Room 109A RHT √ √ 1

By Front Entrance S (1400A) √ √ 1
Front Entrance M √ √ 1
Room 105 RHT √ √ 1
109 Exit M √ √ 1
Room 109 Back HT √ √ 1 Elect. Tested

By 101 S (4098-9601) √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 2451A 2.3-3.7 (Mod 400)
D- Annunciation Indication Confirmed 1400A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 4098-9601 1.0-3.6 (Tru-Test)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Peter Canisius Address: 424 Victoria Street, Watford Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By 101 A M √ √

Hall @ 207 DH √ √

Hall @ 207 DH √ √

Hall @ Gym DH √ √

Hall @ Gym DH √ √

Hall @ Office DH √ √

Hall @ Office DH √ √

Newer Section
In Room 101 EXP-HT √ √ 1 Elect. Tested

By Double Doors S (4098-9601) √ √ 2

By 100 S (4098-9601) √ √ 2
Side Entrance M √ √ 2
By 135 H/S √ √ NAC 2

In Room 135 Left (Library) H/S √ √ NAC 2

In Room 135 Right (Library) H/S √ √ NAC 2

By 135 S (4098-9601) √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 2451A 2.3-3.7 (Mod 400)
D- Annunciation Indication Confirmed 1400A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 4098-9601 1.0-3.6 (Tru-Test)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Peter Canisius Address: 424 Victoria Street, Watford

LOCATION MODEL # BATTERY #RH A B C D REMARKS

By 117 PXM 36 PA-6V7.2 Ah. (09) 2 7.08 10:06 0.32 X See Reps List
By 105 PXM 36 PA-6V7.2 (12) 3 7.08 10:07 0.32

By Gym PXM 36 PA-6V7.2 (12) 2 6.94 10:08 0.33

Gym Exit To Hall PXM 36 PA-6V7.2 (11) 2 6.93 10:09 0.31

Gym Exit Out PXM 36 PA-6V7.2 (14) 2 7.01 10:09 0.30

In 202-A (Daycare Storage) RG 12S160 PS 12V33 (11) 6 13.81 10:10 1.50

By 124 PXM 36 PA-6V7.2 (15) 2 7.21 10:11 0.35

Exit By 129 PXM 36 PA-6V7.2 (08) 2 3.50 10:12 0.21 X See Reps List
By 130 SPEXX10361 (2) 6V4.5 (13) 2 13.71 10:13 0.26

Room 135 SLC 12 250 12V33 (13) 4 13.63 10:14 0.32

Room 135 Exit SPEXX10361 (2) PA-6V4.5 (13) 2 13.82 10:14 0.25 X See Reps List
Room 100C SLA 1272 12V33 (13) 8 13.57 10:15 0.33

By Rm 101 PXM 36 6V7.2(12) 2 7.06 10:15 0.32

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED

Fire Alarm Devices

Repairs Not Required

Emergency Lighting
1 By 117 PXM 36 Replaced battery w/ (1) Panasonic PA-6V7.2 07/11/2016
2 Exit By 129 PXM 36 Replaced battery w/ (1) Panasonic PA-6V7.2 07/11/2016
3 Room 135 Exit SPEXX10361 Replaced battery w/ (2) Panasonic PA-6V4.5 07/11/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 11th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. PETER CANISIUS, 424 VICTORIA STREET, WATFORD
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 11th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 11th, 2016

Building Name: St. Philip

Address: 420 Queens Street, Petrolia

Security/Fire Alarm Panel [Make / Model]: Edwards 6616

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

*Repairs completed during inspection

I A copy of this report has been given to: Paul Lernout - SCCDSB

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Alban Berisha Name: ______________________

CFAA #: 19-996382 CFAA #: _____________________

Signature:______________________ Signature:______________________
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures
√
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures
√
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)]
√
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
√
transmits a trouble to the fire signal receiving centre
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114663 Vikings
Phone Number (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: 1993 Revision: B Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Main Entrance
Control unit or transponder location
Notifier
Control unit or transponder identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Main Entrance
Circuit breaker or disconnect means location Mechanical Room

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 27.66
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.80
in supervisory condition Current (A) 0.120
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.25
in full load condition Current (A) 0.43
The charging current is Current (mA) 0.84

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. (Refer to Appendix F1); √

(iii) Silent accelerated test. (Refer to Appendix F2); √

(iv) A battery capacity meter test. (Refer to Appendix F3); or √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity (refer to Appendix D3.1-C). AH 7
Record the battery terminal voltage after tests are completed. VDC 27.30

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 24 x 0.12 + 0.215 = 3.95
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location
Annunciator or remote trouble signal unit identification

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations
Annunciator or sequential display identification
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations
Remote trouble signal unit identification

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location
Printer Identification

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders, introduce
a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location
Control Unit or Transponder Identification
Data Communication link identification

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Fan Shutdown √

Door Holders √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Philip Address: 420 Queen Street, Petrolia Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Exit By Room 141 M √ √ 2 EOL

By Room 141 S (2451A) √ √ 2 1.30

In Room 141 H √ √ S-1
In Room 134 H √ √ S-2
In Room 138 H √ √ S-2
In Room 130 RHT √ √ 2
Across from Room 130 H √ √ S-1
By Room 130 M √ √ 2
By Room 130 S (2451) √ √ 2 1.43 RB

By Room 130 DH (x4) √ √ AUX

By Room 125D M √ √ 1
By Door S (2451) √ √ 2 1.40 Relay Door Holders

By Room 125A S (1400A) √ √ 1 1.59

By Room 125A H √ √ S-2
HVAC Room By 125A West Wall RHT √ √ 1

HVAC Room By 125A East Wall RHT √ √ 1

By Room # 124A S (1400A) √ √ 1 1.59
HVAC Room By 124A RHT √ √ 1
HVAC Room By 122A RHT √ √ 1
HVAC Room By 135A RHT √ √ 1
Storage in Room 122A RHT √ √ 1

Hall By Room 100A H √ √ S-1

By South Supply (100A) S (1400A) √ √ 1 1.51
160A S (1400A) √ √ 1 1.65
HVAC Room By 129A RHT √ √ 1
By Room 129A S (C2W BA) √ √ 1 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Philip Address: 420 Queen Street, Petrolia Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

By Staff Room H √ √ S-2
By Room 129A M √ √ 1
South Of Office S (C2W BA) √ √ 1 4
Lobby S (1400A) √ √ 1 1.58
Lobby M √ √ 1
Off Boys W / C (103) RHT √ √ 1
Hall By Boys W / C S (1400A) √ √ 1 1.61
Hall By Sick Room H √ √ S-1 EOL

Sick Room RHT √ √ 1

Custodial Rm B RHT √ √ 1
Mechanical Room HT √ √ 1 Elec. Test

Hall By Custodial Rm 109 S (1400A) √ √ 1 1.58

Custodial Room A RHT √ √ 1

101A S (1400A) √ √ 1 1.52

106A S (1400A) √ √ 1 1.61
Room 110D H √ √ S-2
Hub Room off Computer Room RHT √ √ 1
111-A 6H 111-A RHT √ √ 1
Science Storage 111-A RHT √ √ 1
Hall By Meeting 113A S (1400A) √ √ 1 1.59
Meeting Room RHT √ √ 1
Resource HVAC Closet RHT √ √ 1
Hall By Resource H √ √ S-2
Hall By Class 110D S (1400A) √ √ 1 1.56
Room 131 S (1400A) √ √ 1 1.59
Class 4 HVAC RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Philip Address: 420 Queen Street, Petrolia Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Class 4 HVAC RHT √ √ 1
Hall By 108D S (1400A) √ √ 4 1.51
108D RHT √ √ 4
117A RHT √ √ 4
Class 3 HV 110D-HVAC RHT √ √ 4
Hall By Class 110D S (1400A) √ √ 4 1.59
Exit By Class 1410D M √ √ 4
112D RHT √ √ 4
Hall By 120A S (1400A) √ √ 4 1.50
Hall By 120A H √ √ S-1 EOL
Hall By 114D S (2451) √ √ 4 1.41
116D Storage RHT √ √ 4
116D Storage H √ √ S-1
116D Storage RHT √ √ 4
Room 125D RHT √ √ 4

By Gym Entrance S (1400A) √ √ 4 1.56

By Room 112D H √ √ S-2 EOL
In Room 112D H √ √ S-2
By 112D S (1400A) √ √ 4

By 127A M √ √ 4
Girls Change Room RHT √ √ 4
Boys Change Room RHT √ √ 4
Gym H √ √ S-2
Gym Exit M √ √ 4
Gym Storage # 2 M √ √ 4
Class 8110D S (1400A) √ √ 4 1.59

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2451A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 11th, 2016

Building Name: St. Philip Address: 420 Queen Street, Petrolia

LOCATION MODEL # BATTERY RH # A B C D REMARKS

Gym Exit Out PXM 36 PA-6V7.2 (12) 2 6.87 1:10 0.37 OK
Gym Exit To Hall PXM 36 PA-6V7.2 9 (12) 2 7.04 1:11 0.34 OK
Gym Storage RG 12S 360 PA-12V33 (08) 5 13.87 1:12 1.49 X See Reps List
117A RG 12S 144 (2) PA-6V12 (10) 6 13.99 1:13 1.07 X See Reps List
106 6R12A1507M2 (2) 12V7 3 6.86 1:14 0.45 OK
By Room 115D PXM 36 PA-6V7.2 (12) 2 14.13 1:15 0.35 OK
Mech. Rm Lt.-107A (off 107-P) RG 12S 200 (4) PE-6V12 (12) 14 13.93 1:16 0.33 OK
Mech. Rm Rt -107A (off 107-P) RG 12S 144 (2) PA-6V12 (13) 4 13.92 1:16 1.08 OK
130-A RG 12S 360 PA-12V33AH (09) 15 13.90 1:17 1.45 OK
106 By Bathrooms 6R12A1507M2 (2) 12V7 3 13.97 1:18 0.42 OK

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
Repairs not Required

Emergency Lighting
1 Gym Storage RG 12S 360 Replaced battery w/(1) Enersys 12V33 07/11/2016
2 117A RG 12S 144 Replaced battery w/(1) Panasonic 6V12 07/11/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 11th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BD.

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. PHILIP, 420 QUEEN STREET, PETROLIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Alban Berisha CONFIRMED BY: Jim Anderson

CFAA #: 19-996382
FA. REP'S TECH: Alban Berisha DATED: July 11th, 2016
CFAA #: 19-996382
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 6th & 7th, 2016

Building Name: St. Patrick's Catholic High School

Address: 1001 The Rapids Parkway, Sarnia

Security/Fire Alarm Panel [Make / Model]: Edwards EST

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left
in an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination
by the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: _______________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures
√
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and
specification, or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures
√
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)]
√
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
√
transmits a trouble to the fire signal receiving centre
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 114655 Irish
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: 2014 Revision: 5.0 Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Room 126

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 126- FACP
Circuit breaker or disconnect means location Room 126

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V26
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.90
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.30
in supervisory condition Current (A) 0.684
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in full load condition Current (A) 0.763
The charging current is Current (mA) 1246
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 26
Record the battery terminal voltage after tests are completed. VDC 26.70

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 16.8
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 126- FACP BPS # 1-Upper
Circuit breaker or disconnect means location Room 126

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V7.2
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.40
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.00
supervisory condition Current (A) 0.076
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.10
full load condition Current (A) 3.554
The charging current is Current (mA) 1638
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7.2
Record the battery terminal voltage after tests are completed. VDC 26.10

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 3.61
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 126- FACP BPS# 2
Circuit breaker or disconnect means location Room 126

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V7.2
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.40
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.10
supervisory condition Current (A) 0.050
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.40
full load condition Current (A) 1.959
The charging current is Current (mA) 786
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7.2
Record the battery terminal voltage after tests are completed. VDC 26.30

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 2.18
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 222- BPS # 3
Circuit breaker or disconnect means location Room 222- Panel 2C

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V7.2
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.30
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.10
supervisory condition Current (A) 0.105
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.00
full load condition Current (A) 3.096
The charging current is Current (mA) 1414
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7.2
Record the battery terminal voltage after tests are completed. VDC 26.10

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 4.07
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 235-Left BP # 4 (Above Tile, By Wayne's World Poster)
Circuit breaker or disconnect means location By 268- Panel 2E CCT 42

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V7.2
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.50
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.10
supervisory condition Current (A) 0.029
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.00
full load condition Current (A) 3.333
The charging current is Current (mA) 1600
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7.2
Record the battery terminal voltage after tests are completed. VDC 26.30

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 2.37
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 235-Right BPS # 5
Circuit breaker or disconnect means location By 268- Panel 2E CCT 42

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number 12V7.2
Battery manufacturer's date code or ins service date Date 2014
Battery Voltage (main power supply 'ON') is Voltage 26.60
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 26.10
supervisory condition Current (A) 0.123
Battery voltage and current with main power supply 'OFF' and fire alarm system in Voltage 25.30
full load condition Current (A) 3.060
The charging current is Current (mA) 1936
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation. √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7.2
Record the battery terminal voltage after tests are completed. VDC 26.40

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 4.49
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s)
√

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Front Entrance
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location Main Electrical Room # 126, 222
Control Unit or Transponder Identification EST
Data Communication link identification DCLA EST Loop 1, 2

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm, Trouble & Supervisory) √

Fan Shutdown √

Elevator Recall √

BAS Relay √

Aux. Relay √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 1 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

Stairwell 2D H √ √

By Stairwell 2D H/S √ √

Room 228 H/S √ √

By 228 H/S √ √

By 224 H/S √ √

Room 222 H/S √ √

Men's Washroom - Room 220 H/S X See Repairs List

By 220 H/S √ √

Mechanical 218 H/S √ √

Mechanical 218 H/S √ √

By 218 H/S √ √

Fitness 214 H/S √ √

Room 212 H/S √ √

By 203 H/S √ √

Fitness 210 H/S √ √

Fitness 210 H/S √ √

By 208 H/S √ √

By 208 EOL √ √

Stairwell 2C H √ √

Stairwell 2C EOL √ √

By 206 H/S √ √

By 206 EOL √ √

By 206 EOL √ √

By 201-A H/S √ √

By Central Stairwell H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 2 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

By 200 H/S √ √

Room 200 H/S √ √

By 280 H/S √ √

Room 200 H/S √ √

Room 200 H/S √ √

Room 280 H/S √ √

By 278 H/S √ √

Stairwell 2A H √ √

By 243 EOL √ √

By 241 H/S √ √

By 276 H/S √ √

By 239 H/S √ √

By 235 H/S √ √

By 236 H/S √ √

By 234 H/S √ √

By 213 H/S X See Repairs List

Woodshop Mezzanine 230 H/S √ √

Woodshop Mezzanine 230 H/S √ √

By 230 H/S √ √

201 Corridor H/S √ √

By 201F H/S √ √

Room 201 H/S √ √

Room 201 H/S √ √

Room 201A H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 3 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 201A H/S √ √

By 266 H/S √ √

By 264 H/S √ √

By Stairwell 2E H/S √ √

By Stairwell 2E EOL √ √

By Stairwell 2E EOL √ √

Stairwell 2E H √ √

By 215 H/S √ √

Room 240 H/S √ √

By 221 H/S √ √

Room 221 H/S √ √

Room 223 H/S √ √

Room 242 H/S √ √

Room 227 H/S √ √

Room 246 H/S √ √

By 248 H/S √ √

Room 250 H/S √ √

By 252 H/S √ √

By Stairwell 2F H/S √ √

Mechanical 252 H/S √ √

By 256 H/S √ √

By 229 H/S √ √

Room 229 H/S √ √

Room 231 H/S √ √

By 233 H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 4 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

By 258 H/S √ √

By 258 H/S √ √

By 258 H/S √ √

By 210 EOL √ √

By 210 EOL √ √

Room 130 H/S √ √

By 128 H/S √ √

Room 128 H/S √ √

By 139 H/S √ √

Room 134 H/S √ √

Room 134 H/S √ √

Room 134 H/S √ √

By 134 H/S √ √

Room 136 H/S √ √

Room 139 H/S √ √

Room 139A H/S √ √

Room 139B H/S √ √

Room 139B EOL √ √

Room 139B EOL √ √

Room 141 H/S √ √

Room 141A H/S √ √

Room 141B H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 5 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 141 H/S √ √

Room 141D H/S √ √

Room 138 H/S √ √

Room 138 H/S √ √

Room 143 H/S √ √

By 143 H/S √ √

By 100H H/S √ √

Room 100H H/S √ √

By Men's W/C 178 H/S √ √

By 107 H/S √ √

By 180 H/S √ √

By 100J H/S √ √

By 100 H/S √ √

By 100 H/S √ √

100 H/S √ √

Chapel H/S √ √

By 108 H/S √ √

Room 108 H/S √ √

Room 108 H/S √ √

Room 110 H/S √ √

Room 101 H/S √ √

By 112-Cafeteria H/S √ √

By 112-Cafeteria H/S √ √

Room 114 H/S X See Repairs List

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 6 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

By 107 H/S √ √

By 107F H/S √ √

By 107M H/S √ √

By 107C H/S √ √

Room 107C H/S √ √

Stage Left H/S √ √

Stage Left H/S √ √

Stage Right H/S √ √

Stage Right H/S √ √

Cafeteria- Room # 112 H/S √ √

Cafeteria- Room # 112 H/S √ √

Cafeteria- Room # 112 H/S √ √

Cafeteria- Room # 112 H/S √ √

Cafeteria- Room # 112 H/S √ √

By 112G H/S √ √

Servery H/S √ √

Cafeteria- Room # 112 EOL √ √

Cafeteria- Room # 112 EOL √ √

By 116 H/S √ √

Room 113 H/S √ √

By 127A H/S √ √

Room 125A H/S √ √

Room 125A H/S √ √

Room 125 H/S √ √

Room 127A H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 7 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 127A H/S √ √

Room 127 H/S √ √

Room 135 H/S √ √

By 135E H/S √ √

By 135E H/S √ √

Room 133 H/S √ √

Room 133 H/S √ √

Room 135D H/S √ √

Room 126 H/S √ √

Room 116 H/S √ √

By 115 H/S √ √

By 118 H/S √ √

By 124 H/S √ √

Gym 124 H/S √ √

Gym 124 H/S √ √

Gym 124 H/S √ √

Gym 124 H/S √ √

Gym 124 H/S √ √

Gym 124 H/S √ √

By 125 H/S √ √

125 H/S √ √

By 127 H/S √ √

Room 176 H/S √ √

Room 176 H/S √ √

By 176 EOL √ √

By 176 EOL √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 8 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

By 176 H/S √ √

By 174 H/S √ √

Room 174 H/S √ √

Room 174 H/S √ √

Room 172 H/S √ √

Room 172 H/S √ √

By 140 H/S √ √

By 140 EOL √ √

By140 EOL √ √

By 149 H/S √ √

By 152 H/S √ √

Room 142 H/S √ √

By 142 H/S √ √

By 159 H/S √ √

Room 159 H/S √ √

By 148 H/S √ √

By 163 H/S √ √

By 158 H/S √ √

By 160 H/S √ √

By 165 H/S √ √

By 166 H/S √ √

Room 165 H/S √ √

By Locker 1678 H/S √ √

By 168 H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 9 of 9

LOCATION DEVICE A B C D E F SENS. REMARKS

By 170 H/S √ √

Room 170 H/S √ √

By 170 H/S √ √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

1st Floor
Electrical Room 126 IM √ 222
Electrical Room 126 IM √ 223
Corridor CRI-5 South Exit into Gym IM √ 224
Corridor CRI-5 South Exit out of Gym IM √ 225
Corridor CRI-5 Boys Changeroom CT2 √ 226
Room 118 CT2 √ 227
Front of H/C 125C IM √ 228
Front of H/C 127C IM √ 229
South Exit to STR-4 IM √ 230
Construction Tech Beside PNL 1P CR √ 145
Corridor CRI-2 Front of Office 103 IM √ 232
Corridor CRI-2 Front of Room 107 IM √ 233
Sound Booth Theatre Arts Room 107L CR √ 150
Corridor CRI-2 Front of Cafeteria 112 IM √ 235
Manufacturing Tech Room 138 CR √ 149
Room 112F CR √ 206
B/W 112A & 112 CR √ 153
Elevator Room 1 CR √ 158
Front of Sprinkler Room 102 CT-2 √ 162
Rm 100H IM √ 210
Rm 100H IM √ 211
Independent Learning Room 174 IM √ 212
Women's W/C 153 CR √ 185
Room 157 CR √ 182

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Class 144 CR √ √ 181
Class 144 CR √ √ 183
Staff Room 159 CR √ √ 179
Room 161 CR √ √ 180
Room 162 CR √ √ 187
Room 166 CR √ √ 188
Electrical Room 170 IM √ √ 221
Electrical Room 170 IM √ √ 238
Zone 3 IM √ √ 239

2nd Floor
Room 220 IM √ √ 257
At NW Intersection Zone 14 CT2 √ √ 223
At NW Intersection Zone 17 CT2 √ √ 224
At NW Stair #3 (in) IM √ √ 225
At NW Stair #3 (out) IM √ √ 226
Upper Lobby Stair #2 (in) IM √ √ 227
Upper Lobby Stair #2 (out) IM √ √ 228
Room 276 IM √ √ 229
At Stair #1 North Corridor IM √ √ 230
Chapel Northeast Corridor CTI √ √ 231
Chapel Mechanical Room CTI √ √ 232
Chapel Mechanical Room IM √ √ 233
East Corridor at North Intersection IM √ √ 234
North Corridor at Elevator IM √ √ 235

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 280 IM √ √ 236
North Corridor at Room 280 IM √ √ 237
Room 241 CTR √ √ 238
Room 241 CTR √ √ 239
Storage 258 IM √ √ 240
By Mechanical Room 252 IM √ √ 241
By Mechanical Room 252 IM √ √ 242
Mechanical Room 252 CT2 √ √ 243
Mechanical Room 252 CT2 √ √ 242
Mechanical Room 252 CT2 √ √ 245
Mechanical Room 252 CR √ √ 246
Outside Room 252 IM √ √ 247
Beside Stair 5 Exit IM √ √ 248
Beside Stair 5 Exit IM √ √ 337
Construction Tech Mezzanine CR √ √ 250

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 1 of 5

LOCATION DEVICE A B C D E F ZONE REMARKS

1st Floor
Elevator Machine Room 126B S (SIGA) √ √ 1-01 4
Middle of Electrical Room 126 S (SIGA) √ √ 3-02 6
Exit out Back of Electrical Room 126 M √ √ 129-03 6
Hub Room 126A S (SIGA) √ √ 5-04 4
Storage Rm 131 South Exit M √ √ 130-05 4
Corridor CRI-5 South Exit M √ √ 131-06 4
Gym South Exit M √ √ 132-07 5
Gym Storage Exit Southwest M √ √ 133-08 5
Gym Storage Exit Northwest M √ √ 134-09 5
Gym Storage Exit Northwest M √ √ 135-10 5
Gym Storage Exit Southwest M √ √ 136-11 5
Corridor CRI-5 Front of Storage Rm 131 S (SIGA) √ √ 8-12 4
Corridor CRI-5 Front-Boys Changeroom 129 S (SIGA) √ √ 9-13 4
Boys Changeroom # 1- Room 129 S (SIGA) √ √ 10-14 4
Boys Changeroom W/C- Room 129B S (SIGA) √ √ 11-15 4
Boys Changeroom # 2- Room 127 S (SIGA) √ √ 12-16 4
Girls Changeroom # 3- Room 125 S (SIGA) √ √ 13-17 4
Girls Changeroom W/C- Room 123B S (SIGA) √ √ 14-18 4
Girls Changeroom # 4- Room 123 S (SIGA) √ √ 15-19 4
Corridor CRI-5- Rm 125 Front of Girls C/Rm S (SIGA) √ √ 16-20 4
Corridor CRI-5-Front of Girls C/Rm #4- Rm 123 S (SIGA) √ √ 17-21 4
Corridor CRI-5- Front of Gym 124 S (SIGA) √ √ 18-22 4
Changeroom # 5 Room 120 S (SIGA) √ √ 19-23 4
Changeroom # 5 Room 120 North Exit M √ √ 139-24 4

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 2 of 5

LOCATION DEVICE A B C D E F ZONE REMARKS

Corridor CRI-4- Front of Storage Room 115 S (SIGA) √ √ 20-25 4
Corridor CRI-4- Front of Receiving Rm 118 S (SIGA) √ √ 21-26 4
Receiving North Exit Room 118 M √ √ 142-27 4
Mechanical Room 116 S (SIGA) √ √ 22-28 8
Corridor CRI-6 in Front of Stair 3 S (SIGA) √ √ 23-29 4
North Exit to Stair 3 S (SIGA) √ √ 143-30 4
Foyer CRI-3 S (SIGA) √ √ 24-31 1
Corridor CRI-6 & Corridor CRI-4 Intersection S (SIGA) √ √ 25-32 4
Women's Washroom- Room #113 S (SIGA) √ √ 26-33 4
Corridor CRI-6 Front of Girls W/C- Rm #113 S (SIGA) √ √ 27-34 4
Corridor CRI-6-Front of H/C Washrm. 125C S (SIGA) √ √ 28-35 4
Control Booth Room 135E S (SIGA) √ √ 30-36 3
Corridor at Rm. 135F Communication Tech. S (SIGA) √ √ 31-37 3
Corridor CRI-6- Front of H/C Washrm. 127C S (SIGA) √ √ 33-38 4
Boys Washroom- Room #133 S (SIGA) √ √ 34-39 4
Corridor CRI-6- Front of Boys W/C Rm 133 S (SIGA) √ √ 35-40 4
Corridor CR-6- Front of Electrical Rm 126 S (SIGA) √ √ 36-41 4
At Corridor CRI-6 Intersected w/Corridor CRI-7 S (SIGA) √ √ 37-42 4
Corridor CRI-6 South Exit to Stairwell 4 S (SIGA) √ √ 38-43 4
Visual Arts Office/Storage Room 128A RHT √ √ 39-44 4
South Exit Corridor CRI-6 Exit to Stair 4 M √ √ 144-45 4
Construction Tech SW-Right Exit Room 134 M √ √ 146-46 3
Construction Tech SW-Left Exit Room 134 M √ √ 147-47 3
Manufacturing Tech. South Exit Room 138 M √ √ 147-48 3
Corridor 120N- Front of Music Room 141 S (SIGA) √ √ 41-49 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 3 of 5

LOCATION DEVICE A B C D E F ZONE REMARKS

Corridor 170N-Behind Co-op Classroom 143 S (SIGA) √ √ 42-50 3
Corridor 170N & Corridor 101K Intersection S (SIGA) √ √ 43-51 3
Corr 101K Front of Student Suc. Rm 101H S (SIGA) √ √ 44-52 3
Hub Room- Room 107J S (SIGA) √ √ 45-53 3
Guidance Reception Room 101 S (SIGA) √ √ 46-54 3
Changeroom 107G S (SIGA) √ √ 47-55 3
Changeroom 107H S (SIGA) √ √ 48-56 3
Corridor CRI-2 Front of Office Room 103 S (SIGA) √ √ 50-57 1
Corr. CRI-2 Front of Theatre Arts Room 107B S (SIGA) √ √ 51-58 1
Corridor CRI-2 at Cafeteria Doors S (SIGA) √ √ 52-59 1
Sound Booth Room # 107L S (SIGA) √ √ 54-60 3
Northwest Exit from Cafeteria Room # 112 M √ √ 152-61 1
North Left Exit from Cafeteria Room # 112 M √ √ 155-62 1
North Right Exit from Cafeteria Room # 112 M X 154-63 1 See Rep's List
Kitchen North Exit Beside W/C 112G M √ √ 156-64 1
Elevator Machine Room - Elevator 2 S (SIGA) √ √ 103-65 2-7
Foyer 2 in Front of Elevator 1 S (SIGA) √ √ 57 1
Foyer 2- Center of Foyer 2 S (SIGA) √ √ 56 1
Foyer 2 East Exit into Vestibule 1 M √ √ 161 1
Corridor CRI-2 & End of Corridor CRI-8 S (SIGA) √ √ 60 1
Beside Guidance Reception Corr CRI-8 S (SIGA) √ √ 62 2
Front of Attendance Office- Corridor CR1-8 S (SIGA) √ √ 63 2
Girls Washroom- Room # 180 S (SIGA) √ √ 64 2
Boy's Washroom- Room # 178 S (SIGA) √ √ 65 2
Front of Boy's Washroom, Corridor CRI-8 S (SIGA) √ √ 66 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 4 of 5

LOCATION DEVICE A B C D E F ZONE REMARKS

Front of Lg. Meeting Rm 100H, Corr. CRI-8 S (SIGA) √ √ 67 2
Special Education Vestibule, V-03 M √ √ 178-76 96
Corridor CRI-8 & Corridor CRI-9 Intersection S (SIGA) √ √ 70-77 2
CRI-8 East Side of Tech 138 S (SIGA) √ √ 81-78 2
CRI-9 Front of Independant Learning Rm. 174 S (SIGA) √ √ 76-79 26
West Exit to Stair 5 M √ √ 184-80 26
CRI-9 Front of West Exit to Stair 5 S (SIGA) √ √ 78-81 26
Corridor CRI-9 & Corridor CRI-12 Intersection S (SIGA) √ √ 83-82 26
Corridor CRI-9- In Front of Girls W/C 153 S (SIGA) √ √ 79-83 26
Corr. CRI-9-In Front of Standard Classrm 155 S (SIGA) √ √ 75-84 26
Corr. CRI-9-In Front of Standard Classrm 142 S (SIGA) √ √ 77-85 26
Lan Rm 165B S (SIGA) √ √ 72-86 26
Corr. CRI-9-In Front of Standard Classrm 146 S (SIGA) √ √ 80-87 26
Corridor CRI-9 & Corner of Corridor CRI-10 S (SIGA) √ √ 82-88 26
Above Ceiling In Front of Custodial 161 SD √ √ 73-89 46
Corr. CRI-10 Front of Academic Storage 163 S (SIGA) √ √ 85-90 26
Above Ceiling Front of Acad. Storage 163 SD √ √ 84-91 46
Corridor CRI-11 South Exit to Stair 6 M √ √ 189-92 26
CRI-11 in Front of South Exit to Stair 6 S (SIGA) √ √ 94-93 26
CRI-11 in Front of Standard Class 162 S (SIGA) √ √ 96-94 26
CRI-11 in Front of Staff Washroom 165A S (SIGA) √ √ 86-95 26
CRI-11 In Front of Classroom # 166 S (SIGA) √ √ 98-96 26
CRI-11 In Front of Classroom # 168 S (SIGA) √ √ 93-97 26
East Exit to Vestibule V-02 M √ √ 186-98 26
CRI-11 & Corner of Corridor CRI-12 S (SIGA) √ √ 95-99 26

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 5 of 5

LOCATION DEVICE A B C D E F ZONE REMARKS

Electrical Rm 170 S (SIGA) √ √ 92-100 25
Girls Washroom 153 S (SIGA) √ √ 97-101 26
Boys Washroom 149 S (SIGA) √ √ 91-102 26
Corr. CRI-12, Beside Learning Strategies 172 S (SIGA) √ √ 90-103 26
Corridor CRI-7- Front of Co-op Class 143 S (SIGA) √ √ 94-104 3
CRI-7 Front of Manufacturing Tech. 138 S (SIGA) √ √ 101-105 3
CRI-7 In Front of Music Rm Entrance # 141 S (SIGA) √ √ 99-106 3
CRI-7 In Front of Construc. Tech Rm.134 S (SIGA) √ √ 71-107 3
Corridor CRI-7- In Front of Room 139 S (SIGA) √ √ 102-108 3

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 1 of 4

LOCATION DEVICE A B C D E F ZONE REMARKS

2nd Floor
Elevator Shaft HT √ √ 252-04 Elev. 2
In Room 222 S (SIGA) √ √ 253-05 16
Room 218 1st Floor Supply DS √ √ 255-06 17
Room 218 2nd Floor Supply DS √ √ 256-07 17
Room 220 Boys Washroom S (SIGA) √ √ 257-08 14
West Corridor at Room 220 S (SIGA) √ √ 258-09 14
West Corridor at Room 218 S (SIGA) √ √ 259-10 14
West Corridor at Room 205 S (SIGA) √ √ 260-11 14
West Corridor at Room 203 S (SIGA) √ √ 261-12 14
Room 212 Girls Washroom S (SIGA) √ √ 262-13 14
West Corridor at Room 210 S (SIGA) √ √ 263-14 14
West Corridor at Room 208 S (SIGA) √ √ 264-15 14
Northwest Stair #3 ( C ) S (SIGA) √ √ 266-16 3
Northwest Stair #3 M √ √ 392-17 14
North Corridor at Room 206 S (SIGA) √ √ 268-18 11
North Corridor at Room 204 S (SIGA) √ √ 269-19 11
West High Ceiling S (SIGA) √ √ 271-20 1
Upper Lobby North S (SIGA) √ √ 272-21 11
Upper Lobby South S (SIGA) √ √ 273-22 11
East High Ceiling at Main Stair 2 (B) S (SIGA) √ √ 274-23 1
East High Ceiling at Main Stair # 2 S (SIGA) √ √ 275-24 1
At Upper Caf Windows N. Corridor S (SIGA) √ √ 278-25 11
At Room 202 North Corridor S (SIGA) √ √ 279-26 11

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 2 of 4

LOCATION DEVICE A B C D E F ZONE REMARKS

At Room 200A Staff Washroom S (SIGA) √ √ 281-27 11
At Room 200B Staff Washroom S (SIGA) √ √ 280-28 11
North Stair #1 (A) S (SIGA) √ √ 283-29 11
At North Stair #1 M √ √ 393-30 11
North Corridor at Room 276 S (SIGA) √ √ 285-31 11
High Ceiling in Chapel S (SIGA) √ √ 286-32 1
High Ceiling in Front of Chapel S (SIGA) √ √ 288-33 1
High Ceiling in Front of Chapel S (SIGA) √ √ 289-34 1
High Ceiling in Front of Chapel S (SIGA) √ √ 290-35 1
North Corridor at Elevator S (SIGA) √ √ 292-36 11
Elevator Shaft 1 HT √ √ 294-37 Elev.2-9
In Room 280 S (SIGA) √ √ 296-38 10
North Corridor at Room 280 S (SIGA) √ √ 298-39 11
East Corridor at Bridge S (SIGA) √ √ 299-40 11
East Corridor at Room 241 S (SIGA) √ √ 300-41 12
East Corridor at Room 274 S (SIGA) √ √ 301-42 12
East Corridor at Room 237 S (SIGA) √ √ 302-43 12
East Corridor at Room 270 S (SIGA) √ √ 303-44 12
Corridor CR2-2 By Upper Lobby S (SIGA) √ √ 277-45 11
CR2-6 at Intersection w/Corridor CR2-5 S (SIGA) √ √ 304-46 12
Corridor CR2-6 At Room 266 S (SIGA) √ √ 305-47 12
Corridor CR2-6 At Room 264 S (SIGA) √ √ 306-48 12
Girls Washroom 219 S (SIGA) √ √ 308-49 18
Boys Washroom 215 S (SIGA) √ √ 309-50 18
CR2-10 Front of Academic Storage Rm 258 S (SIGA) √ √ 310-51 18

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 3 of 4

LOCATION DEVICE A B C D E F ZONE REMARKS

Corridor CR2-10 Beside Classroom 233 S (SIGA) √ √ 311-52 18
Corner of Corridor CR2-10 & CR2-9 S (SIGA) √ √ 312-53 18
Corridor CR2-9 Front of Class 233 S (SIGA) √ √ 313-54 18
CR2-9 Front of Science Bio Room 231 S (SIGA) √ √ 314-55 18
CR2-9 Front of Science Bio Room 231 S (SIGA) √ √ 315-56 18
CR2-9 Front of Science Bio Room 229 S (SIGA) √ √ 316-57 18
Corner of Corridor CR2-9 & CR2-8 S (SIGA) √ √ 317-58 18
CR2-8 Front of Stair 6 S (SIGA) √ √ 318-59 18
STAIR
Top Landing of Stair 6 (F) S (SIGA) √ √ #6 18
Pull Station at Exit to Stair 6 2nd Floor M √ √ 400-61 18
Above Mech Room 252 Door DS √ √ 320-62 45
CR2-8 in Front of Mech Room 252 S (SIGA) √ √ 319-63 45
Left Duct in Front of Mech Room 252 S (SIGA) √ √ 326-64 45
Mechanical Room 252 Ceiling S (SIGA) √ √ 324-65 19
Corner of CR2-8 & CR2-7 S (SIGA) √ √ 327-66 102
CR2-7 Science Room 246 S (SIGA) √ √ 328-67 102
Lan Room 225 S (SIGA) √ √ 329-68 102
CR2-7 Front of Science Prep Room 223 S (SIGA) √ √ 330-69 102
CR2-7 Front of Chem Science Room 221 S (SIGA) √ √ 331-70 102
CR2-7 Front of Washroom Entrance S (SIGA) √ √ 332-71 102
CR2-7 at T-Intersection w/ CR2-10 S (SIGA) √ √ 333-72 102
Detector at Top of Stair #5 M √ √ 336-73 Stairs 23

Pull Station at Exit to Stair #5 S (SIGA) √ √ 408-74 102

CR2-6 in Front of Exit to Stair #5 S (SIGA) √ √ 334-75 102
CR2-5 Beside Room 235 S (SIGA) √ √ 338-76 13
CR2-5 Front of Business Classes 234-235 S (SIGA) √ √ 339-77 13

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARoom
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 4 of 4

LOCATION DEVICE A B C D E F ZONE REMARKS

CR2-5 Front of Business Class 234 S (SIGA) √ √ 340-78 13
CR2-5 Front of Tech Mezz 230 E S (SIGA) √ √ 341-79 13
CR2-5 Front of Tech Mezz 230 W S (SIGA) √ √ 342-80 13
Duct Smoke for Supply Rm AHU 102 Tech Mezz 230 SD √ √ 343-81 14
Ceiling of South Stair #4 S (SIGA) √ √ 345-83 Stair 2-23

Pull Station at South Stair #4 Exit 2nd Fl M √ √ 410-84 14

CR2- Front of Stair #4 Exit S (SIGA) √ √ 347-85 14
CR2-Front of Intersection w/ CR2-5 S (SIGA) √ √ 348-86 14
Corridor CR2 Front of Elevator #2 S (SIGA) √ √ 349-87 14

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia

LOCATION MODEL # BATTERY A B C D REMARKS

Mechanical Room 202 RG12S360 PA-1233 (12) 13.90 9:00
Hall by 212 RG12S360 PA-1233 (15) 14.10 9:02
Room 222 RG12S360 PA-1233 (09) 13.10 9:04 X √ See Repairs List
Room 201 Entrance 5LER4502 (2) 6V7 (13) 13.10 9:08
Room 201 RG12S250 (4) 6V12 (13) 13.50 9:09
Hall by 266 RG12S360 PA-1233 (15) 14.00 9:06
Room 258 RG12S250 (4) PA-6V12 (13) 13.20 9:11
Mechanical Room 252 RG12S250 (2) 6V7 (13) 13.30 9:13
Room 256 RG12S250 (4) PA-6V12(13) 14.01 9:16
Stairwell 1F 5LER4502 (2) 6V7 (13) 13.15 9:18
Room 161 RG12S250 (4) 6V12 (13) 13.20 9:20
Room 142B RG12S250 (4) 6V12 (13) 13.20 9:22
Stairwell 1E 5LER4502 (2) 6V7 (13) 13.01 9:24
Hall By 176 RG12S360 PA-1233 (09) 13.41 9:26 X √ See Repairs List
Room 115 RG12S360 PA-1233 (15) 14.16 9:39
Room 138- Welding RG12S250 (4) 6V12 (13) 13.91 9:28
Room 138 Exit 5LER4502 (2) 6V7 (13) 13.81 9:30
Room 134 Woodshop RG12S250 (4) 6V12 (13) 13.64 9:32
Room 134 Exit Left 5LER4502 (2) 6V7 (13) 13.73 9:34
Room 134 Exit Right 5LER4502 (2) 6V7 (13) 13.18 9:37 X √ See Repairs List
Room 126 Electrical RG12S360 PA-1233 (15) 14.10 9:33
Room 124E- Gym Storage RG12S360 PA-1233 (11) 13.03 9:37 X √ See Repairs List
Room 124G- Gym Storage RG12S360 PA-1233 (11) 13.07 9:35 X √ See Repairs List
Room 115 RG12S360 PA-1233 (15) 14.16 9:39
Storage Room 114 RG12S250 PA-1233 (15) 13.61 9:39
Room 112B- Servery RG12S360 PA-1233 (12) 13.71 9:41
Room 107E off of 107 RG12S360 (4) 6V12 (13) 13.17 9:45 X √ See Repairs List
Safe Room 100L RG12S3250 PA-1233 (12) 13.48 9:50 X √ See Repairs List
Room 201A 5LER4502 (4) 6V7 (13) 13.43 10:00

A- Battery Float Voltage (AC Power On)

B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
SPRINKLERS
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 1 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS

Sprinkler Room- Alarm Valve ESV √ 24 √
Sprinkler Room- Main Control Valve ESV √ 24 √
Sprinkler Room FS √ √ 25
Room 3 FS √ √ 25
Room 3 PS √ √ 41
Room 3 PS √ √ 42

Room P- 1504 Receiving ESV √ 47 √

Room P- 1504 FS √ √ 30
Hall by Gym (by 1511) ESV √ 48 √
Hall by Gym (by 1511) FS √ √ 31
Hall by Main Office ESV √ 46 √
Hall by Main Office ESV √ 45 √
Hall by Main Office FS √ √ 29
Hall by Main Office FS √ √ 28
By Main Entrance ESV √ 43 √
By Main Entrance FS √ √ 26
2nd Flr Chapel Mezz. Rm. 267 ESV √ 49 √
2nd Flr Chapel Mezz. Rm. 267 FS √ √ 32
By Room 2101 ESV √ 50 √
By Room 2101 FS √ √ 33
In 2101 ESV √ 51 √
In 2101 FS √ √ 34
By Room 2320 ESV √ 52 √

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
SPRINKLERS
INDIVIDUAL DEVICE RECORD
Date: July 6th & 7th, 2016

Building Name: St. Patrick's High School Address: 1001 Rapids Parkway, Sarnia Page 2 of 2

LOCATION DEVICE A B C D E F SENS. REMARKS

By Room 2320 FS √ √ 35
By Room 2320 FS √ √ 36

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED

Fire Alarm

1 North Right Exit from Cafeteria Room # 112 M Replaced (1) Manual Pull Station Glass Rod 08/24/2016
2 Men's Washroom - Room 220 H/S Replaced Device w/ (1) GIR-HDVM Horn Strobe 08/24/2016
3 By 213 H/S Replaced Device w/ (1) GIR-HDVM Horn Strobe 08/24/2016
Obstruction Removed, Found Device Damaged. Required
4 Room 114 H/S replacement 08/24/2016

Emergency Lighting
1 Room 222 RG12S360 Replaced Battery w/ (1) Enersys NP33-12 08/24/2016
2 Hall By 176 RG12S360 Replaced w/ (1) Enersys NP33-12, (1) 12V Bipin Lamp 08/24/2016
3 Room 134 Exit Right 5LER4502 Replaced PC Board w/ (1) CB-093 08/24/2016
4 Room 124E- Gym Storage RG12S360 Replaced Battery w/ (1) Enersys NP33-12 08/24/2016
5 Room 124G- Gym Storage RG12S360 Replaced Battery w/ (1) Enersys NP33-12 08/24/2016
6 Room 107E off of 107 RG12S360 Replaced w/ 12 Volt Single Remote Head 08/24/2016
7 Safe Room 100L RG12S250 Replaced w/ (1) 12V Bipin Lamp 08/24/2016

Sprinkler Repairs
1 Sprinkler Repairs Completed. See Report.

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a
complete building audit of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the
authority having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record
 183 Exeter Rd., Unit 183
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St. Patricks

Building Occupancy Type: Instititional Hazard: Light

Address: 1001 Rapids Parkway Inspector: T.Neves
City/Province: Sarnia Date: July 6, 2016
Date: Aug. 24, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #16

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is building completely sprinklered? YES
f) Are all new additions and renovations properly protected? N/A
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? YES
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? Supervised

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? YES

b) The static pressure was? 62psi
c) The residual pressure was? 58psi
d) Type of water supply? CITY

1001 Rapids Parkway wo#21461 Aug 2016 Insp.xls 1

 4. TANKS, PUMPS & SIAMESE:

a) Are siamese connections in good condition, couplings free, caps in place and ball drips open? YES
(chrome)
5. FIRE HYDRANTS:

N/A

6. WET SYSTEMS:

# of wet systems: 2 Make & Model: Reliable Model E

a) Are alarm valves in good condition? YES

b) Are flow switches working and in good condition? YES
c) Are tamper switches working and in good condition? YES
d) Is the excess pressure pump functional? YES
e) Is the valve trimmed properly? YES
f) The operation of the excess pressure pump is? AUTO
g)The excess pressure pump automatically starts at? 107psi
h)The excess pressure pump automatically stops at? 122psi

7. DRY SYSTEMS:

8. ANTI-FREEZE SYSTEMS: N/A

9. SPECIAL SYSTEMS:

N/A

10. STANDPIPE SYSTEMS:

N/A

11. ALARMS:

a) Did the water motor gong test satisfactorily? YES

b) Did the electric alarm test satisfactorily? YES
c) Did the supervisory alarms test satisfactorily? YES
d) The low pressure switch sends a low pressure warning at? 81/86psi

1001 Rapids Parkway wo#21461 Aug 2016 Insp.xls 2

 12. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? YES
b) Are the sprinklers less than 50 years old? YES
c) Are there spare sprinklers and a wrench in the head cabinet? No
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? YES
e) Have the sprinklers been checked for the proper temperature rating? YES

13. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Sprinkler Room Alarm Valve-West Sprinkler Operational
Main Control Valve Sprinkler Operational
Low Pressure Switch (PS120) Sprinkler Operational
Flow Pressure Switch (PS10) Sprinkler Operational
Alarm Valve-East Sprinkler Operational
Main Control Valve Sprinkler Operational
Low Pressure Switch (PS120) Sprinkler Operational
Main Control Valve City Supply Operational
in front of Gym Hall Flow Switch Gr. Gym Operational
Butterfly Control Valve Gr. Gym Operational
Receiving/ Custodian Flow Switch Grd. Flr. West Spr. Operational
#116 Butterfly Control Valve Grd. Flr. West Spr. Operational
in front of Office Flow Switch Grd. Flr. South Spr. Operational
Butterfly Control Valve Grd. Flr. South Spr. Operational
in front of Office Flow Switch Grd. Flr. East Spr. Operational
Butterfly Control Valve Grd. Flr. East Spr. Operational
Main Entrance Flow Switch Grd. Flr. North Spr. Operational
Butterfly Control Valve Grd. Flr. North Spr. Operational
Chapel Mezzanine Flow Switch 2nd Flr. North Spr. Operational
Butterfly Control Valve 2nd Flr. North Spr. Operational
in front of Rm. 2241 Flow Switch 2nd Flr. East Spr. Operational
Butterfly Control Valve 2nd Flr. East Spr. Operational
in front of Rm. 2210 Flow Switch 2nd Flr. West Spr. Operational
Butterfly Control Valve 2nd Flr. West Spr. Operational
in front of Rm. 2210 Flow Switch Mech. Rm. 2nd Flr. Operational
Butterfly Control Valve Mech. Rm. 2nd Flr. Operational
Shop Room Control Valve Dust Collector Not in Service
(Anti-freeze System)
In Room 2101 Butterfly Control Valve 2nd Flr. South Spr. Not in Service
In Room 2101 Flow Switch 2nd Flr. South Spr. Not in Service
2nd Floor Mech Room 4" Butterfly Control Valve 1st Flr C Wing Spr Operational
2nd Floor Mech Room Flow Switch 2nd Flr C Wing Spr Operational
2nd Floor Mech Room 4" Butterfly Control Valve 2nd Flr C Wing Spr Operational
2nd Floor Mech Room Flow Switch 2nd Flr C Wing Spr Operational
2nd Floor Mech Room 2-1/2" Butterfly Control Valve Mech Room Spr Operational
2nd Floor Mech Room Flow Switch Mech Room Spr Operational

1001 Rapids Parkway wo#21461 Aug 2016 Insp.xls 3

 14. Listed are recent changes in the building occupancy or fire protection equipment.

NONE

15. The following are corrections made at the time of inspection.

NONE

16. DEFICIENT ITEMS:

*No spare sprinkler head wrench in head box.** Installed Aug. 24th, 2016
*Room 116 Mech. Rm. Re-install removed sprinkler head and piping.**Installed Aug. 24th, 2016

The above items are deficient as per The Ontario Fire Code and need to be corrected immediately.
A certificate of inspection cannot be issued until all items under section #16 have been addressed.
Consultation with the local fire prevention office is suggested, if discrepancies occur

17. The following items are recommendations only.

NONE

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item, component or
system in the building. Further, it is mutually agreed that the maximum amount of joint and several liability the
INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of warrantee, negligent
hiring, or any other theory of liability including violation of a statute or consumer protection act is strictly limited
to the FEE PAID for the inspection report.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify
that the sprinkler system installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report
would be required to certify this).

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the local
Fire Prevention office

1001 Rapids Parkway wo#21461 Aug 2016 Insp.xls 4

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 6th & 7th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. PATRICKS CATHOLIC HIGH SCHOOL, 101 THE RAPIDS PARKWAY, SARNIA
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE SPRINKLER SYSTEM & FIRE HYDRANT HAVE ALSO BEEN INSPECTED
AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Kevin Bury DATED: August 24th, 2016
CFAA #: 19-995199
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 2nd, 2016

Building Name: St. Ursula

Address: 426 Lacroix Street, Chatham

Security/Fire Alarm Panel [Make / Model]: Mircom FA-1000

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the; Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992081 CFAA #: _____________________

Signature: _________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Damar Keypad Code 1951 Name DAMAR- 883340 Chargers
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Electrical Room 121A off of Boiler Room 121

Control unit or transponder identification Mircom FA-1000

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Room 121A off of Boiler Room 121
Circuit breaker or disconnect means location Room 121A off of Boiler Room 121

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number NP-1212
Battery manufacturer's date code or ins service date Date 2015
Battery Voltage (main power supply 'ON') is Voltage 26.10
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 25.50
system in supervisory condition Current (A) 0.22
Battery voltage and current with main power supply 'OFF' and fire alarm Voltage 24.90
system in full load condition Current (A) 0.95
The charging current is Current (mA) 1349

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 12
Record the battery terminal voltage after tests are completed. VDC 25.80

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 5.73
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location Main Entrance
Annunciator or remote trouble signal unit identification Mircom

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: Manual Visual √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Room 100
Annunciator or sequential display identification BB-1001
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders (2) √

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: St. Ursula Address: 426 Lacroix Street, Chatham Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

West Exit by Rm 124 M (# 10) √ √ 5 EOL

Hall By Room 126 S (6249C) √ √ 5

Hall By Room 126 B √ √ S-3 EOL

Mechanical Room 128 RHT √ √ 5

Custodial Room 128A RHT √ √ 5

Custodial Room Exit 128A M (# 9) √ √ 5

Hall By Room 120 B √ √ S-2 EOL

Hall By Room 120 S (C2M PDI) √ √ 5 Relay Base

Hall By Room 118 Hall Doors S (C2W BA) √ √ 3

Hall By Room 118 S (1400A) √ √ 3

Staff Work Room 130 RHT √ √ 3

Staff Work Room Rear 130A RHT √ √ 3

Staff Room C1321 RHT √ √ 3

Storage Room 111 RHT √ √ 3

Hall By 134 S (6249C) √ √ 4

Hall By Room 119 B √ √ S-2

Hall By Room 119 S (6249C) √ √ 4

Room 119 RHT √ √ 4

Exit By Room 119 M (# 8) √ √ 4 EOL

Hall By Room 118 B √ √ S-3

Exit By Room 116 M (# 7) √ √ 3

Exit By Room 116 S (C2M PDI) √ √ 3

Hall By Room 105 S (C2M PDI) √ √ 3

Library Office 105 RHT √ √ 3

French Room 103 RHT √ √ 3

Hall Exit 102 M √ √ 2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: St. Ursula Address: 426 Lacroix Street, Chatham Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Main Library 101 RHT √ √ 3 High

Library Study (Left) RHT √ √ 3

Library Study (Right) RHT √ √ 3

Library Study Exit M (# 6) √ √ 3

Hall By Library B √ √ S-2

Hall By Library 101 S (C2M PDI) √ √ 3

Room Exit 112 M (# 5) √ √ 3

Store Room By Staff W/C 110 RHT X 2 See Repairs List

South Exit By Room 4 M (# 1) √ √ 2

Hall By Altar S (C2M PDI) √ √ 2

Hall By Staff W/C Room 108 S (6249C) √ √ 2

Closet by Room 108 RHT √ √ 2

Hall By Office B √ √ S-2

Hall By Office S (6249C) √ √ 2

Exit By Office Main Entrance M (# 1) √ √ 2

Custodian Room RHT √ √ 2

Photocopy Storage RHT √ √ 2

Hall By Boiler 121 S (C2M PDI) √ √ 2

Boiler Room HT √ √ 2 Elect. Tested

Electrical Room RHT √ √ 2 EOL

Storage Room 125 RHT √ √ 1

Hall By Boys W/C 127 B √ √ S-2

Hall By Boys W/C 127 S (C2M PDI) √ √ 2

Hall By Room 144 S (C2M PDI) √ √ 2

Exit By Room 144 M (# 2) √ √ 2

Gym Storage RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: St. Ursula Address: 426 Lacroix Street, Chatham Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS/REPAIRS

Gym Right Exit M √ √ 1

Gym B √ √ S-1

Gym Exit By Stage M √ √ 1

Gym Hall To Stage 123 S (6249C) √ √ 2

Gym Stage RHT √ √ 1 High

Stage Left RHT √ √ 1 High

Front Entrance Ann √ √

Right Mezzanine RHT √ √ 1 High

Under Stage Center HT-RES. √ √ 1

Hall to West Wing By Room 9 Door Holders √ √ S-2

Hall By Room 9 Aux Relay √ √ S-2

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1400A 1.0-2.4 (Mod 400)
E- Circuit Number or Address 2400A 0.8-1.56 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 2nd, 2016

Building Name: St. Ursula Address: 426 Lacroix Street, Chatham

LOCATION MODEL # BATTERY RH# A B C D REMARKS

Gym West Wall RG 36 PA-6V12 (06) N/A N/A 2:00 Panel PPB cct 19

Gym East Wall SLA-36 PA-6V7.2 (14) N/A N/A 2:00 Panel LPA cct 39

Boiler Room RG 36 PA-6V12 (10) 2 N/A 2:00 Panel PPB cct 28

By Library RG 36 PA-6V12 (10) 2 N/A 2:00 Panel PPB cct 36

Library RG 36 PA-6V12 (13) N/A N/A 2:00 Panel LPA cct 6

By Room 117 PC9-36 UB670 (12) N/A N/A 2:00 Plug

Mechanical Room 12 MSL 360 BB EP33-12 (10) 6 N/A 2:00 Plug

A- Battery Float Voltage (AC Power On)

B- Test Start Time
C- Requires Service, Repairs, Missing
D- Repairs Completed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Store Room By Staff W/C 110 RHT Replaced Device w/ (1) Mircom 5601A Detector 03/02/2016

Emergency Lighting
No Repairs Required

Additional Comments:
Portable Zone Has Been Re-Labelled To Correct Zone # 5
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: St. Ursula

Address: 426 Lacroix Street Inspector: T.Neves
City/Prov: Chatham Date: July 22, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section # 6

1. GENERAL:
a) Are the hydrant(s) free from obstructions and accessible? YES
b) Are the hydrant(s) visible and clearly marked? YES

2. WATER SUPPLIES:
a) Was a flow test done? YES
b) Was water flowed from the hydrant for a minimum time of one minute with the valve fully open? YES
c) Was the water free of debris? YES
d) Type of water supply? City Water Supply
3. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
i) The static pressure was? 52
j) The pitot reading from an engineered playpipe was 35 Using an outlet size of 2.5
k) The USGPM results are? 993

426 Lacroix wo#21428 July 2016 Insp.xls 1

4. Listed are recent changes in the building occupancy or fire protection equipment:

NONE

5. The following are corrections made at the time of inspection:

NONE

6. The following items are deficient as per The Ontario Fire Code and need to be corrected immediately:

NONE

The certificate of inspection cannot be issued until all items under section #6 have been completed.

7. The following items are recommendations only.

NONE

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT
certify that the fire hydrant installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s
report would be required to certify this).

LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT
warranting or guaranteeing the adequacy, performance or life expectancy of any structure, item,
component or system in the building. Further, it is mutually agreed that the maximum amount of joint and
several liability the INSPECTOR can incur for any error, mistakes, omissions, breach of contract, breach of
warrantee, negligent hiring, or any other theory of liability including violation of a statue or consumer
protection act is strictly limited to the FEE PAID for the inspection report.
As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the
local Fire Prevention office

426 Lacroix wo#21428 July 2016 Insp.xls 2

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 2nd, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. URSULA~ 426 LACROIX STREET, CHATHAM

HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE FIRE HYDRANT HAVE ALSO BEEN INSPECTED AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: August 30th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: August 12th, 2016

Building Name: St. Vincent

Address: 9399 McNaughton Line, Chatham

Security/Fire Alarm Panel [Make / Model]: Mircom FA-101T

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed during inspection

I A copy of this report has been given to: Paul Lernout

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Martin Archibald Name: ______________________

CFAA #: 19-992091 CFAA #: _____________________

Signature: ________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]

YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre √
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR- 883341 Vikings
Phone Number 1 (800) 265-7562
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location By Boiler Room 113

Control unit or transponder identification Mircom FA-101T

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location By Boiler Room 113
Circuit breaker or disconnect means location Boiler Room Panel LPN CCT # 7

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]
YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number (2) Enersys NP7-12
Battery manufacturer's date code or ins service date Date 2011
Battery Voltage (main power supply 'ON') is Voltage 26.60
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.50
in supervisory condition Current (A) 0.066
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.20
in full load condition Current (A) 0.585
The charging current is Current (mA) 0.89

INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 7
Record the battery terminal voltage after tests are completed. VDC 25.40

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 2.01
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations N/A
Annunciator or sequential display identification N/A
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location N/A
Control Unit or Transponder Identification N/A
Data Communication link identification N/A

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm) √

Door Holders (2) √

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 12th, 2016

Building Name: St. Vincent Address: 9399 Mc Naughton Line E., Chatham Page 1 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Gym Exit Right M √ √ 1

Gym Back RHT √ √ 1 High

Gym Centre RHT √ √ 1 High

Gym Front RHT √ √ 1 High

Gym Exit Left M √ √ 1

Gym B √ √ NAC-1

Gym Electrical Rm S (C2M PDI) √ √ 1

Girls Change Room S (6249C) √ √ 1

Boy’s Change Rm S (C2M PDI) √ √ 1

Gym Stage RHT √ √ 1 Elect. Tested

Hall By Gym S (C2M PDI) √ √ 1

Hall By Gym B √ √ NAC-1

East Exit M √ √ 1

East Exit S (C2M PDI) √ √ 1

Gym Storage RHT √ √ 1

Hall By Office M √ √ 1

Hallway French B √ √ NAC-1

French Paper Storage RHT √ √ 1

FSL Room RHT √ √ 1

French Storage RHT √ √ 1

French Computer RHT √ √ 1

French Computer M √ √ 1

Hall By Office RHT √ √ 1

Staff Room Front RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 12th, 2016

Building Name: St. Vincent Address: 9399 Mc Naughton Line E., Chatham Page 2 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Staff Room Back RHT √ √ 1

Staff Room Exit M √ √ 1

Hall By Staff Room M √ √ 1

Slop Sink In Boys Washroom 111A RHT X 1 See Repairs List

Uniform Storage RHT √ √ 1

Boiler Room 113 HT √ √ 1 Elect. Test

Boiler Room M √ √ 1

Paint Storage 115 RHT X 1 See Repairs List

Hall By Resource B √ √ NAC-1

Custodian Room 117R RHT √ √ 1

Resource Office RHT √ √ 1

Room 1 (06) RHT √ X √ 1 See Repairs List

Room 1 Storage RHT √ √ 1

Room 4 RHT √ √ 1

Room 4 Storage RHT √ √ 1

Reading Room RHT √ √ 1

Reading Room Hall by M √ √ 1

Library RHT √ √ 1

Hall By Library B √ √ NAC-1

Mr McLain Room 11 RHT √ √ 1

Hall By Library RHT √ √ 1

NW Exit M √ √ 1

Hall By NW Exit S (C2M PDI) √ √ 1

Room North Classroom 112 RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: August 12th, 2016

Building Name: St. Vincent Address: 9399 Mc Naughton Line E., Chatham Page 3 of 3

LOCATION DEVICE A B C D E F SENS. REMARKS

Room 37 RHT √ √ 1

Hall By Room 37 RHT √ √ 1

Centre Hall B √ √ NAC-1

EOL
Storage Room 42 RHT √ √ 1

Room 36 RHT √ √ 1

Hall By Room 36 RHT √ √ 1

Room 35 RHT √ √ 1

Room 33 RHT √ √ 1

NE Exit M √ √ 1 EOL
Hall By NE Exit RHT √ √ 1

Hall By Office Door Holder (2) √ √ Aux

On Signal CCT Contacts
Hall By Library Door Holder (2) √ √ Aux

Room 41 Day Care RHT √ √ 1

A- Correctly Installed Required Sensitivity

B- Requires Service, Repairs, Missing or Cleaning C2M PDI 4-7 Blinks (Magnet)
C- Alarm Operation Confirmed 6249C 0.6-1.8 (Solo Trutest)
D- Annunciation Indication Confirmed 1451A 0.9-2.1 (Mod 400)
E- Circuit Number or Address 2451A 2.3-3.7 (Mod 400)
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: August 12th, 2016

Building Name: St. Vincent Address: 9399 Mc Naughton Line E., Chatham

LOCATION MODEL # BATTERY RH# A B C D REMARKS

Brk # 11 in Panel G in Gym
Gym Exit Out RG 36 REI PA-6V7.2 (11) 2 N/A 12:40 N/A X Elec. Rm. See Repairs List

Stage Stairs RG 36 Magnavolt (15) 2 6.99 12:42 N/A

Brk # 9 in Panel G in Gym
Gym Entrance RG 36 REI PA-6V7.2 (13) 2 6.89 12:40 N/A Elec. Rm

Hall By Gym RG 36 PA-6V12 (14) 2 6.85 12:40 N/A Brk # 9 in panel G

Storage Room # 23 RG 36 PA-6V7.2 (14) 2 7.01 12:43 N/A

Hall By Office, Unit # 7 RG 36 PA-6V12 (14) 2 7.06 12:44 N/A
Hall By Resource, Unit # 6 RG 36 PA-6V7.2 (09) 2 6.96 12:45 N/A X See Repairs List
Hall By Library, Unit # 5 RG 36 PA-6V12 (10) 2 7.00 12:47 N/A X See Repairs List
NW Exit, Unit # 4 RG 36 Magnavolt SLA6-12 (12) 2 6.99 12:49 N/A
NE Hall, Unit # 3 RG 36 B612OP (12) 2 7.04 12:50 N/A
Hall Beside Rm. 35, Unit # 2 RG 36 PA-6V12 (13) 2 7.01 12:51 N/A
NE Exit, Unit # 1 RG 36 PA-6V12 (11) 2 6.97 12:53 N/A X See Repairs List
Early Learning Room (Rm. 41) SLA12072 (2) VB670 (12) 2 14.11 12:54 N/A

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & EMERGENCY LIGHTING

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Mircom Fire Alarm Panel FA-101T Replaced Batteries w/ (2) EnerSys NP7-12 08/12/2016
2 Slop Sink In Boys Washroom 111A RHT Replaced Device w/ (1) 5601A Heat Detector 08/12/2016
3 Paint Storage 115 RHT Replaced Device w/ (1) 5601A Heat Detector 08/12/2016
4 Room 106 RHT Replaced Device w/ (1) 5601A Heat Detector 08/12/2016

Emergency Lighting

1 Gym Exit Out RG 36 REI Replaced Battery w/ (1) Panasonic PA-6V7.2 08/12/2016
2 Hall By Resource, Unit # 6 RG 36 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/12/2016
3 Hall By Library, Unit # 5 RG 36 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/12/2016
4 NE Exit, Unit # 1 RG 36 Replaced Battery w/ (1) Panasonic PA-6V7.2 08/12/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: August 12th, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
ST. VINCENT~ 9399 MC NAUGHTON LINE, CHATHAM
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING
OF FIRE ALARM SYSTEMS, CAN/ULC-S536-04.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Martin Archibald CONFIRMED BY: Jim Anderson

CFAA #: 19-992091
FA. REP'S TECH: Martin Archibald DATED: August 12th, 2016
CFAA #: 19-992091
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM

INSPECTION & TEST REPORT [Ref. CAN/ULC-S536-04]

This report covers the following inspection: Semi-Annual Annual X

Date: July 20th & 21st, 2016

Building Name: Ursuline College

Address: 85 Grand Avenue West, Chatham

Security/Fire Alarm Panel [Make / Model]: Edwards EST

YES NO N/A

A System provides single-stage operation √

B System provides two-stage operation √

C System provides pre-action or cross-zone operation √

The entire fire alarm system has been inspected and tested in accordance with CAN/ULC-S536, Inspection & Testing
D of Fire Alarm System √

E The fire alarm system documentation is on site and includes a description of the system √

F The fire alarm system is fully functional √

G The fire alarm system has deficiencies noted on the attached pages √
H Comments:

* All repairs completed as of August 30th, 2016

I A copy of this report has been given to: Paul Lernout - SCCDSB

Who is the: Owner or Owner's Representative X for this building

The information on this form (and the documents attached here-to) attest to the fact that the equipment listed here-in was tested/inspected in
conformance with applicable codes, bylaws, standards, and the manufacturer's requirements by a qualified technician. The equipment was left in
an operational condition except as noted in the spaces marked "comments". A copy should be maintained on the premises for examination by
the Fire Marshall or Inspector at their request.

Technician #1 Technician #2

Name: Kevin Bury Name: ______________________

CFAA #: 19-995199 CFAA #: _____________________

Signature: _________________________ Signature: _____________________

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM SYSTEM DOCUMENTATION [Ref. CAN/ULC-S536-04]

The fire alarm system has all the required documentation; X YES NO
CONTROL UNIT OR TRANSPONDER TEST RECORD
YES = tested correctly NO = Did not test correctly N/A = Not Applicable (function or feature not provided on third fire alarm system)
CONTROL UNIT OR TRANSPONDER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.2.1]
YES NO NA
Power 'ON' visual indicator √
Common visual trouble signal √
Common audible trouble signal √
Trouble signal silence switch √
Main power supply failure trouble signal operates √
Ground fault tested on positive and negative trouble signal √
Alert signal operation √
Alarm signal operation √
Automatic transfer from alert signal to alarm signal √
Manual transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Automatic transfer from alert signal to alarm signal cancel (acknowledge) feature operates on a two-stage system √
Alarm signal silence inhibit function operates √
Alarm signal manual silence operational √
Alarm signal silence visual indication operates √
Alarm signals, when silenced automatically reinitiate upon subsequent alarm √
Alarm signal silence automatic cut-out timer Time: √
Audible and visual alert signals and alarm signals programmed and operate per design and specification; or documentation as detailed
in Appendix C - Description of Fire Alarm System for Inspection and Test Procedures √
Input circuit, alarm and supervisory operation, including audible and visual indication operates √
Input circuit supervision fault causes a trouble indication √
Output circuit alarm indicates operational √
Output circuit supervision fault causes a trouble indication √
Visual indicator test (lamp test) √
Coded Signal sequences operate not less than the required number of times and the correct alarm signal operates thereafter √
Coded signal sequences are not interrupted by subsequent alarm √
Ancillary device by-pass will result in a trouble signal √
Input circuit to output circuit operation, including ancillary device circuits, for correct program operation, as per design and specification,
or documentation as detailed in Appendix C - Description of Fire Alarm System for Inspection and Testing Procedures √
Fire alarm system reset operation √
Main power supply to emergency power supply transfer operates √
Status change confirmation (smoke detectors only) verified [Refer Subsection 5.7.4.3, Status Change Confirmation (Alarm Verification
Feature)] √
Receipt of alarm transmission to the fire signal receiving centre √
Receipt of the supervisory transmission to the fire signal receiving centre √
Receipt of the trouble transmission to the fire signal receiving centre √
Operation of the fire signal receiving centre disconnect means results in a specific trouble at the control unit or transponder and
transmits a trouble to the fire signal receiving centre
√
Record the name and telephone number of the fire signal receiving centre √
Name DAMAR-883342 Lancers
Phone Number (519) 336-7111
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

VOICE COMMUNICATION TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.3.1]

YES NO N/A

Power 'ON' indicator operates √

Common visual trouble signal operates √

Common audible trouble signal operates √

Trouble signal silence switch operates √

All call voice paging, including visual indicator operates √

Output circuits for selective voice paging, including visual indication operates √

Output circuits for selective voice paging trouble operation, including visual indication operates √

Microphone including press to talk switch operates √

Operation of voice paging does not interfere with entitled inhibit time of alert signal and alarm signal √

All call voice paging operates (on emergency power supply) √

Upon failure of one amplifier, system automatically transfers to back up amplifier(s) √

Circuits for emergency telephone call in operation, including audible and visual indication operates √

Circuits for emergency telephone for operation, including two-way voice communication operates √

Emergency telephone verbal communication operates √

Emergency Telephone Operable or in-use tone at handset operates √

CONTROL UNIT OR TRANSPONDER INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.2.4.1]

YES NO N/A

Input circuit designations correctly identified in relation to connected field devices √

Output circuit designations correctly identified in relation to connected field devices √

Correct designations for common control functions and indicators √

Plug-in components and modules securely in place √

Plug-in cables securely in place √

Cleanliness and free of dust and dirt √

Record the date, revision and version of firmware: √

Date: Revision: Version:

Record the date, revision and version of the program software: √

Date: Revision: Version:

Fuses in accordance with the manufacturer’s specification √

Control unit/transponder lock is functional √

Termination points for wiring to field devices secure √

Control unit or transponder location Electrical Room

Control unit or transponder identification EST

 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room - FACP
Circuit breaker or disconnect means location Electrical Room - 808

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number NP38-12B
Battery manufacturer's date code or ins service date Date 2015
Battery Voltage (main power supply 'ON') is Voltage 26.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.00
in supervisory condition Current (A) 1.14
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.90
in full load condition Current (A) 1.71
The charging current is Current (mA) 1112
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 38
Record the battery terminal voltage after tests are completed. VDC 26.00

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 28.13
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room - Booster 1 Supply Lower
Circuit breaker or disconnect means location Electrical Room - 808

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number PK-12V13
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 26.20
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.70
in supervisory condition Current (A) 0.05
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.40
in full load condition Current (A) 1.19
The charging current is Current (mA) 505
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 13
Record the battery terminal voltage after tests are completed. VDC 26.10

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 1.77
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

POWER SUPPLY INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.1]

YES NO N/A

Fused in accordance with the manufacturer's marked rating of the system √

Adequate to meet the requirements of the system √

Control unit or transponder location Electrical Room - Booster 2 Supply Top
Circuit breaker or disconnect means location Electrical Room - 808

EMERGENCY POWER SUPPLY TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.3, 5.3.2, 5.33]

YES NO N/A

Correct battery type as recommended by the manufacturer √

Correct battery rating as determined by battery calculations based on full system load √

Terminals cleaned and lubricated √

Terminals clamped tightly √

Batteries free from physical damage √

Correct electrolyte level √

Specific gravity of the electrolyte is within the battery manufacturer’s specifications √

Inspected for electrolyte leakage √

Adequately ventilated √

Disconnection causes trouble signal √

Generator provides power to the AC circuit serving the fire alarm system. √
Trouble condition at the emergency generator results in an audible common trouble signal and a visual indication at the required
annunciator. √

Battery voltage not less than 85% of its rated capacity after tests completed √
Battery manufacturer and part number PK-12V13
Battery manufacturer's date code or ins service date Date 2012
Battery Voltage (main power supply 'ON') is Voltage 26.30
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 26.00
in supervisory condition Current (A) 0.06
Battery voltage and current with main power supply 'OFF' and fire alarm system Voltage 25.70
in full load condition Current (A) 0.97
The charging current is Current (mA) 356
INDICATE TYPE OF BATTERY TEST PERFORMED (must choose 1 of 5 methods)

YES NO N/A

(i) Required supervisory load for 24 h followed by the required full load operation; √

(ii) Silent test using load resistor method for full duration test. √

(iii) Silent accelerated test. √

(iv) A battery capacity meter test. √

(v) Replace the batteries with a new set having a current date code/capacity/type √
Record battery capacity AH 13
Record the battery terminal voltage after tests are completed. VDC 26.00

BATTERY CAPACITY CALCULATION

Required Battery Capacity (Ah): 1.86
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

ANNUNCIATOR AND REMOTE TROUBLE SIGNAL UNIT TEST & INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory input zone clearly indicated and separately designated √

Individual alarm and supervisory input zone designation labels are properly identified √

Common trouble signal operates √

Visual indicator test (lamp test) operates √

Displays are visible in the installed location √

Input wiring from control unit or transponder is supervised and of the correct type and gauge in accordance with the equipment
manufacturer’s installation wiring requirements √

Alarm signal silence visual indicator operates √

Switches for ancillary functions operate as per design and specification. √

Other Ancillary functions visual indicators operates √

Manual activation of alarm signal and indication operates √

Operates on emergency power √

Annunciator or remote trouble signal unit location N/A
Annunciator or remote trouble signal unit identification N/A

ANNUNCIATOR AND SEQUENTIAL DISPLAY [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.2]

YES NO N/A

Power 'ON' indicator operates √

Individual alarm and supervisory zone indication operates (see exception) √

Exception: Operation of each individual alarm and supervisory zone indication gives the identical indication, or lights the identical
indicators at the other annunciator(s) and sequential display(s) √

Specify method of confirmation: √

Minimum of one alarm zone and one supervisory zone tested per annunciator or sequential display to confirm operation √

Input wiring from control unit or transponder is supervised √

Alarm signal silence visual indicator operates. √

Switches for ancillary functions operate as per design and specification. √

Individual alarm and supervisory input zone designation labels are properly identified. √

Common trouble signal operates. √

Visual indicator test (lamp test) operates. √

Displays are visible in the installed location. √

Operates on emergency power √

Manual activation of alarm signal and indication operates. √

Other ancillary functions visual indicators operates. √

Annunciator or sequential display locations Main Entrance, Auditorium Entrance, By Exit 13
Annunciator or sequential display identification EST
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

REMOTE TROUBLE SIGNAL UNIT TEST AND INSPECTION [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.3]

YES NO N/A

Input wiring from control unit or transponder is supervised √

Visual trouble signal operates √

Audible trouble signal operates √

Audible trouble signal silence operates √

Remote trouble signal unit locations N/A
Remote trouble signal unit identification N/A

PRINTER TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.4, 5.4.1]

YES NO N/A

Operates as per design and specification, or in accordance with documentation provided in Appendix E. √

Zone of each alarm initiating device is correctly printed. √

Rated voltage is present. √

Printer Location N/A
Printer Identification N/A

DATA COMMUNICATION LINK TEST [Ref. CAN/ULC-S536-04, Clauses 5.1.5, 5.6 Note]

YES NO N/A
Confirm that a trouble signal is received at the control unit or transponder under an open loop fault for each data communication link
(DCL) √
Where fault isolation modules are installed in data communication links serving field devices, wiring shorted on the isolated side,
annunciation of the fault confirmed, and then a device on the source side operated, and activation confirmed at the control unit or √
Where fault isolation in data communication links is provided between control units or transponders and between transponders,
introduce a short circuit fault and confirm annunciation of the fault and operation outside the shorted section between each pair of: √

(i) Control Unit to Control Unit √

(ii) Control Unit to Transponder √

(iii) Transponder to Transponder √

Control Unit or Transponder Location Electrical Room 808
Control Unit or Transponder Identification EST
Data Communication link identification DCCA 1,2,3

ANCILLARY DEVICE CIRCUIT TEST [Ref. CAN/ULC-S536-04, Clauses 4.2.2.1-AA, C5.1-AA]

CAUTION: The test reported on this form do not include the actual operational test on ancillary devices
Operation of
RECORD SPECIFIC TYPE OF ANCILLARY CIRCUIT Ancillary Circuit
Confirmed

YES NO N/A

Security Tie (Alarm & Trouble) √

Door Holders √

Pager Transmitter √
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 1 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Denomy W
0104
Top of Stairs By Room 921 S √ √ A2.3 0014
0104
Exit By 921 M √ √ A2.1 0044
0104
921 Back Hall S √ √ A2.1 0029

921 Back Hall H/S √ √ LB 4

0104
By Room 921 S √ √ A2.1 0028

Hall By Room 921 H √ √ LB 4

0104
Hall By Sink Room 920 S √ √ A2.1 0026

By Room 920 H √ √ LB 4
0104
Back Hall off 919 S √ √ A2.1 0027 NL

Back Hall off 919 H √ √ LB 4

0103
Hall By 918 S √ √ D2.1 0040
0103
Room 918 RHT √ √ D2.1 0024

By Room 918 H √ √ UB 1
0103
Top of Stairs By 918 S √ √ D2.1 0011
0103
Exit By Top of Stairs by 918 M √ √ D2.1 0130
0103
Room 915 RHT √ √ D2.1 0073
0103
Back Room off 915 HT (284-C) √ √ D2.1 0131 Elect. Tested
0103
By Room 916 S √ √ D2.1 0039

By Room 916 H √ √ NAC-2

0103
Room 914 RHT √ √ D2.1 0025
0103
Room 913 RHT √ √ D2.1 0026

By 914 H √ √ UB 1
0104
Top of Stairs to Mech. Rm (Penthouse) S √ √ D3.2 0160

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 2 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0104
Mechanical Room East M √ √ D3.1 0160

3rd Mechanical Room (Denomy) H/S √ √ UB 1

0104
Mechanical Room East RHT √ √ D3.1 0071
0104
Mechanical Room Exit to Roof M √ √ D3.1 0161
0103
Mechanical Room West M √ √ D3.1 0039
0103
Mechanical Room West RHT √ √ D3.1 0070
0103
By Room 912 S √ √ D2.1 0038
0103
Prep Room 912 RHT √ √ D2.1 0027
0103
Room off 912 (Storage Room) RHT √ √ D2.1 0028
0103
Room 910 RHT √ √ D2.1 0029
0103
Room 909 RHT √ √ D2.1 0033

By 909 H √ √ NAC-2
0103
By 909 S √ √ D2.1 0037
0103
Chem Lab 908 RHT √ √ D2.1 0030
0103
Room 907 (Prep Room) RHT √ √ D2.1 0031
0103
Back Room off 907 (Prep Room) RHT √ √ D2.1 0032

By 908 H √ √ UB 1
0104
Top of Elevator Shaft RHT Tested By Edwards D2.4 0046
0103
Bio Lab 905 RHT √ √ D2.1 0034
0103
Prep Room 906 RHT √ √ D2.1 0035
0103
Back Room off 906 RHT √ √ D2.1 0041
0103
Room 904 RHT √ √ D2.1 0042
0103
By Room 904 S √ √ D2.1 0036
0103
Top of Stairs at 901 M √ √ D2.1 0032

By 901 H √ √ NAC-2

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 3 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Fan Room By 901 RHT √ √ D2.1 0043
0103
Top of Stairs By 901 S √ √ D2.3 0073

Denomi 1st Floor

Bottom of Stairs By 801 H √ √ NAC-2
0103
Room 801 RHT √ √ D1.1 0089

Room 802 H/S √ √ NAC-2

0103
Room 802 Right RHT √ √ D1.1 0176
0103
Room 802 Left RHT √ √ D1.1 0077
0103
Room 802 M √ √ D1.1 0046
0103
Back Room off 802 HT √ √ D1.1 0146 Elect. Tested

Room 804 Workshop H/S √ √ NAC-2

0103
Room 804 Right RHT √ √ D1.1 0078
0103
Room 804 Left RHT √ √ D1.1 0079
0103
Room 804 M √ √ D1.1 0147
0103
Office off 804 HT √ √ D1.1 0148 Elect. Tested

Hall By 804 H √ √ UB 1
0103
Room 805 Main Left RHT √ √ D1.1 0080
0103
Room 805 Main Right RHT √ √ D1.1 0087
0103
Room 805 Back Area RHT √ √ D1.1 0082
0103
Office off Back Area RHT √ √ D1.1 0183
0103
Office By Exit RHT √ √ D1.1 0184
0103
Bottom of Stairs By 801/802 M √ √ D1.1 0184
0103
Bottom of Stairs By 801/802 S √ √ D1.1 0088
0103
Room 805 Rear H √ √ D1.1 0088

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 4 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Exit Near Office Off 805 M √ √ D1.1 0150

Computer Room off Prep Room H √ √ UB 1

Computer Room off Prep Room RHT √ √ D1.1

0103
By 805 S √ √ D1.2 0087

Prep Room H √ √ UB 1

Hall By Prep Room H √ √ NAC-2

0103
Storage By 804 (Room 806) RHT √ √ D1.1 0091
0103
By 807/805 S √ √ D1.2 0086

By 807 H √ √ UB 1
0103
Hall By 808 (Atrium) S √ √ D1.2 0017 NL
0103
Room 808 M √ √ D1.2
0127
0103
Elevator Room RHT √ √ D1.2 0020
0103
Room 809 RHT √ √ D1.2 0018

Room 809 Range Hood Not Tested By AEI D1.2

0103
Hall By 810/809 S √ √ D1.2 0016

Hall By 810 H √ √ NAC-2

0103
810 Exit M √ √ D1.2 0129
0103
Hall By 811/813 S √ √ D1.2 0015
0103
Room 811 RHT √ √ D1.2 0018
0103
Custodial Rm By 813 (Main Water Rm) RHT √ √ D1.2 0014

Custodial Rm By 813 (Main Water Rm) FS 128 2nd -Arts

Custodial Rm By 813 (Main Water Rm) LPS 130 Ground- Arts

Tested By C&H
Custodial Rm By 813 (Main Water Rm) ESV 131 Ground- Arts

Custodial Rm By 813 (Main Water Rm) ESV 136 Fire Pump Run

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 5 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Custodial Rm By 813 (Main Water Rm) TS 430 Denomy Main

Custodial Rm By 813 (Main Water Rm) TS 430 Denomy Main

Custodial Rm By 813 (Main Water Rm) ESV 421 STD Pipe

Custodial Rm By 813 (Main Water Rm) ESV 407 Grud East

Custodial Rm By 813 (Main Water Rm) ESV 421 STD Pipe

Custodial Rm By 813 (Main Water Rm) ESV Tested By C&H 126 2nd Arts

Custodial Rm By 813 (Main Water Rm) LP 408 Denomy East

Custodial Rm By 813 (Main Water Rm) FS (Main Water) 409 Denomy Ground

Custodial Rm By 813 (Main Water Rm) FS 129 Ground Arts

Custodial Rm By 813 (Main Water Rm) LP 127 2nd Arts

Custodial Rm By 813 (Main Water Rm) ESV 132 Arts Main ESV

Hall By Electrical Room H √ √ UB 1

0103
Electrical Room 808 RHT √ √ D1.2 0013
0103
Electrical Room 809 RHT √ √ D1.2 0012
0103
Exit to Stair By Electrical M √ √ D1.2
0019
0103
Entrance By Auditorium M √ √ A1.1 0137
0104
By 816 S √ √ A1.1 0019

By 816 H √ √ LB 3

Drama Office Closet RHT √ √ A1.1

0104
Hall By Female W/C S √ √ A1.1 0020

Hall By Exit H √ √ LB 3
0104
By 815 S √ √ A1.1 0021

By 814 H (G1RF-HD) X LB 3 See Repairs List

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 6 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0104
By 814 S √ √ A1.1 0022
0104
Exit By Stage Left/Special Events Exit M √ √ A1.1 0139

Stage Left H √ √ LB 3

Stage Right H √ √ LB 3
0104
Auditorium Exit Right South M √ √ A1.1 0140

Auditorium Right H √ √ LB 3

Auditorium Rear (Centre) H √ √ LB 3

Auditorium Left H √ √ LB 3
0104
Entrance to Orchestra Pit S √ √ A1.1 0015 High
0104
Ramp Off Auditorium Left (West Corridor) S √ √ A1.1 0016
0104
Ramp Exit Near Room 816 S √ √ A1.1 0017

Ramp off Auditorium Left H √ √ LB 3

Lobby Northwest H √ √ LB 3
0104
Lobby Northwest M √ √ A1.1 0143
0104
Lobby Northwest- Foyer North S √ √ A1.1 0025
0104
Lobby Southwest M √ √ A1.1 0141

Lobby Southwest H √ √ LB 3
0104
Lobby Southwest- Foyer Centre S √ √ A1.1 0024
0104
Lobby Southwest by W/C- Foyer South S √ √ A1.1 0023

Stage- Upper H/S √ √

Administration Hallway
0103
Staff W/C RHT √ √ A1.1 0021
0103
By Handicap W/C H √ √ NAC-2
0021

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 7 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Main Lobby S √ √ D1.3 0072
0103
Main Exit South M √ √ D1.3 0140
0103
Main Exit North M √ √ D1.3 0142

Admin Front Office H √ √ UB 1

0103
Admin Copy Room RHT √ √ D1.3 0066
0103
Admin Breakroom (Café) RHT √ √ D1.3 0068
0103
Admin Computer Room/ Security RHT √ √ D1.3 0068
0103
Hall By VP's Office RHT √ √ D1.3 0067
0103
Hall By Library- 707 S √ √ D1.3 0071

Hall By Library H √ √ NAC-2

0103
Library Exit to Outside (707) M √ √ D1.3 0144
0103
Hall By 705 (Library South) S √ √ D1.3 0027

Hall By 705 H √ √ UB 1
0103
Hall Doors By 705 M √ √ D1.3 0145
0104
Main Gym Entrance- East M √ √ G1.1 0145

Right of Main in Gym Entrance NE H √ √ UB 4

Gym Office RHT √ √

Hall to Changeroom H √ √ UB 1
0104
Boy's Changeroom (West) RHT √ √ G1.2 0043
0104
Boy's Storage Room RHT √ √ G1.2 0044
0104
Girl's Changeroom (East) RHT √ √ G1.2 0041
0104
Girl's Storage Room RHT √ √ G1.1 0042
0103
Boys Change Room Exit M √ √ G1.2 0141

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 8 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Gym Storage RHT √ √ G1.1
0104
Entrance to Fitness Room M √ √ G1.1 0048
0104
Gym Ceiling NE RHT √ √ G1.1 0037
0104
Gym Ceiling SE RHT √ √ G1.1 0036
0104
Gym Ceiling NW RHT √ √ G1.1 0038
0104
Gym Ceiling SW RHT √ √ G1.1 0035
0104
Gym SW Exit Hall RHT √ √ G1.1 0033
0104
Gym Under Stage Right RHT √ √ G1.1 0031
0104
Gym Under Stage Left RHT √ √ G1.1 0032
0104
Gym Stage RHT √ √ G1.1 0034
0104
Gym SE Exit Hall RHT √ √ G1.1 0030
0104
Gym SE Exit Hall M √ √ G1.1 0146

Gym SE H X UB 4 See Repairs List

0103
Gym Award Hall- North M √ √ C1.1 0402 West Caf. Hall Exit
0103
Gym Award Hall- Caf. W. Corr @ Vest. S √ √ C1.1 0309 RB
0103
Gym Award Hall SE-Caf. W. Corr Cen. S √ √ C1.1 0308
0103
Hall By SE Gym Entrance S √ √ C1.1 0302
0103
Hall at Greenhouse S √ √ C1.1 0306

Greenhouse H √ √ NAC-2
0103
Greenhouse Exit to # 10 M √ √ C1.1 0405
0104
Hall to Merici @ East Storage S √ √ M1.2 0063 RB
0104
Storage @ Merici Stair (SE) RHT √ √ M1.2 0058

Gym S/W Hall Exit M √ √ G1.1 147

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 9 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Hall to Merici H √ √ UB 1
0104
Exit to #9/ Merici South Corr. Exit M √ √ M1.2 0155
0104
By Exit # 9/ Merici at Elev. Lobby S √ √ M1.2 0164 RB
0104
Elevator Room RHT √ √ M1.2 0065
0104
Hall By Locker #2089/Merici N. & Stair S √ √ M1.2 0057
0104
By Exit # 6/ Merici SW Exit S √ √ M1.2 0059
0104
By Exit # 6/ Merici SW Exit M √ √ M1.2 0154
0104
Hall By 507/ Merici North S √ √ M1.2 0156

Hall By 507 H √ √ UB 1
0104
Hall By 508/ Merici W. Centre Exit S √ √ M1.2 0165
0104
Exit By 508/ Merici Centre W. Exit M √ √ M1.2 0153

Fitness Room H √ √ UB 1
0104
Fitness Room/ Merici NW Exit #4 M √ √ M1.2 0152

Fitness by Mechanical Room H √ √ UB 1

Fitness Mech Room ESV 425 Main ESV- Merici

Fitness Mech Room ESV 422 Xavier- Main

Fitness Mech Room FS 434 Xavier- Flow

Fitness Mech Room LPS 433 Xavier- Low Pressure

Fitness Mech Room LPS 431 Merici Low Pressure

Tested By C&H
Fitness Mech Room FS 436 Merici Grd. Floor

Fitness Mech Room ESV 424 Xavier Ground ESV

Fitness Mech Room ESV 423 Greenhouse ESV

Fitness Mech Room ESV 435 Merici Grd. Floor ESV

Merici Main Flow- See
Fitness Mech Room FS 432 Reps. List

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 10 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Fitness Mech Room FS 428 Greenhouse Flow

Fitness Mech Room FS Tested By C&H 429 Merici 2nd Floor

Fitness Mech Room ESV 406 Merici 2nd Floor ESV

0103
Top of Stairs By 610- Merici N. Stair S √ √ M2.5 0312
0103
Hall By 610- 2nd @ N. Stair S √ √ M2.1 0277
0103
Exit By 610 M √ √ M2.1 0378

Hall By 610 H √ √ LB 2
0103
Hall By 609 S √ √ M2.1 0276

Hall By W/C H √ √ LB 2
0103
Sink Room By W/C RHT √ √ M2.1 0267
0103
Hall By 608 S √ √ M2.1 0272
0103
Room 608 Storage RHT √ √ M2.1 0273
0103
Hall By 607 S √ √ M2.1 0271

Hall By 606 H √ √ LB 2
0104
Top of Elevator Shaft RHT √ √ M2.4 -
0067
0103
Hall By Storage/Computer Storage S √ √ M2.1 0270
0103
Hall on Ramp at Stair S √ √ M2.1 0268
0103
Top of Stairs at 601/ Centre Stair S √ √ M2.2 0262
0103
Exit By 601/ Merici @ Centre Stair M √ √ M2.1 0377
0103
Custodial Rm RHT √ √ M2.1 0267

Exit By 601 H √ √ LB 2
0103
Hall By 601 S √ √ M2.1 0263
0103
In Room 602 DS √ √ M2.8 0266 (above tile)
0103
Hall By 605/ Merici at South Stair S √ √ M2.2 0258
0103
In Room 604 DS √ √ M2.7 0265 (above tile)

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 11 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Exit By 603/ Merici at S. Stair M √ √ M2.2 0367

Exit By 603 H √ √ LB 1 EOL

0104
Top of Stair By 603/ Merici S. Stair S √ √ M2.3 0069
0104
Exit By 503/ @ South Stair M √ √ M1.1 0156

Exit By 503 H √ √ LB 1
0104
Hall By Chapel/ 505 S √ √ M1.1 0061
0104
Hall By 501 S √ √ M1.1 0060
0104
Custodial Room RHT √ √ M1.1 0062
0104
Exit By 501 M √ √ M1.1 0151

Exit By 501 H √ √ LB 2

Storage Under Stair North RHT √ √

0104
Exit to Stairs (400's) M √ √ MB.1 0149

Exit to Stairs (400's) By Mech. Rm. H √ √ LB 2

0104
Custodial RM RHT √ √ MB.1 0050
0104
Mech Room RHT √ √ MB.1 0053
0104
Mech Room Storage Right N RHT √ √ MB.1 0048
0104
Mech Room Storage Left S RHT √ √ MB.1 0047
0104
Hall By Electrical Room S √ √ MB.1 0051
0104
Electrical Room RHT √ √ MB.1 0049
0104
Hall By 402 S √ √ MB.1 0052
0104
Exit By 403- #35 M √ √ MB.1 0150

Exit By 403 H √ √ LB 1
0104
Stairwell Storage South RHT √ √ M2.2 0068
0104
Staff Room Exit to Hall M √ √ M1.3 0158

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 12 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0104
Staff Room Exit Out - West M √ √ M1.3 0157

Staff Room H √ √ LB 2 EOL

0103
Hall By Locker # 1639/ South Corr. C. S √ √ C1.1 0305

Centre Hall H √ √ NAC-2 EOL

0103
Hall By Exit 11/ Caf. Hall At Servery S √ √ C1.1 0304
0103
Hall By Exit 11/ Caf. S. Corr. Exit M √ √ C1.1 0401
0103
Hall By Servery/ Caf. @ S. Door S √ √ C1.1 0310
0103
Storage Under Stairs By Old Gym RHT √ √ CB.2 0284
0103
Boy's Changeroom (Lower) RHT √ √ CB.2 0285
0103
Girl's Changeroom (Lower) RHT √ √ CB.2 0286
0103
By Exit # 18/ Caf. NW Exit M √ √ C1.1 0313
0103
Outside Boiler Room M √ √ C1.1 0399
0103
Outside Boiler Room HT (284C) √ √ 0398 Elect. Tested

Outside Boiler Room - Left H/S √ √ UB 3

0103
Outside Boiler Room- NE M √ √ 047/4
0399
0103
Electrical Room RHT √ √ 298/3
0298
0103
Top of Stair at Custodial Room CAF N. Stair S √ √ C1.1 0065
0103
Custodial Room RHT √ √ C1.1 0299

Resource Room 703 H √ √ NAC-2

0103
Exit # 17- Vending Rm. Exit M √ √ C1.1 0392
0103
Exit # 17- Vending Rm. Exit RHT √ √ C1.1 0297

Old Gym H √ √ UB 3
0103
Servery HT √ √ C1.1 0300 Elect. Tested
0103
Servery HT √ √ C1.1 0300 Elect. Tested

Cafeteria Office RHT √ √ 295/3

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 13 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Cafeteria West RHT √ √ 300
297/
Cafeteria South Exit M √ √
C1.1
396/
Cafeteria North Exit M √ √
C1.1
By Student Room H √ √ UB 3
0103
Student Council Room RHT √ √ 0301
0103
Hall By Exit 15/ Caf. @ Lobby East S √ √ C1.1 0303
0103
Hall By Exit 15/ Caf. East Corr. Exit M √ √ C1.1 0400

Hall By Men's W/C H X UB 3 See Repairs List

0103
Sink Room By Cafeteria RHT √ √ C1.1 0302
0103
Custodial @ CAF E. Exit RHT √ √ C1.1 0315
0103
Dance Entrance Room 310 M √ √ C2.1 0133

Dance Entrance Room 310 H √ √ UB 3

0103
Rear Exit Hall off 310 M √ √ C2.1 0134
0103
NE Storage Room off Dance Hall RHT √ √ C2.1 0144
0103
Mechanical Rm off Dance Hall Front E RHT √ √ C2.1 0046
0103
Mechanical Room Rear W. RHT √ √ C2.1 0045

Mechanical Room Rear H √ √ NAC-2

0103
Dance Hall East South Storage RHT √ √ C2.1 0093
0103
Dance Hall East North Storage RHT √ √ C2.1 0092
0103
Rear Dance Hall Stairs/ Caf. SE Stair S √ √ C1.1 0296
0104
Xavier Stair @ 309- Xavier N. Stair S √ √ X2.2 0076
0103
At 309- 2nd @ North Stair M √ √ X2.1 0382
0103
By 301 S √ √ X2.1 0279

By 302 H √ √ LB 2

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 14 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Top of Elevator RHT √ √ X2.4
0311
3rd Floor Mechanical Room FS 379 Xavier 2nd
Tested By C&H
3rd Floor Mechanical Room SV 380 Xavier 2nd

3rd Floor Mechanical Room Rear HT √ √ 381 Elec Test

0103
Custodial Supplies By 307 RHT √ √ X2.1 0282
0103
By 307 S √ √ X2.1 0278
0103
By 305 S √ √ X2.1 0283

By 304 H √ √ UB 2
0103
By 304/ South Stair M √ √ X2.1 0383
0103
Top of Stairs By 304 S √ √ X2.3 0047
294/ 0103
Hall By Exit # 13/ Student Services S √ √ X1.2 0794 Xavier Lobby
0103
Entrance to Student Services M √ √ X1.1 0390
0103
Custodial Room RHT √ √ 293 0293

Copy Room H √ √ UB 3
Exit to # 12 H √ √ UB 2
0103
Exit to # 12 M √ √ X1.2 0391

By 204 H √ √ UB 2
0103
By 204 M √ √ X1.1 0389
0103
By 205 S √ √ X1.1 0390
0103
By Custodial Supplies/ 207 S √ √ X1.1 0287
0103
Custodial Supplies RHT √ √ X1.1 0289

Hall 2nd By W/C H √ √ UB 3

0103
Centre Hall Mechanical Room RHT √ √ X1.1 0288

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 15 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Centre Hall Mechanical Room FS 385 Xavier Ground Floor

Centre Hall Mechanical Room ESV 386 Xavier Ground Floor

Tested By C&H
Centre Hall Mechanical Room FS 387 Cafeteria

Centre Hall Mechanical Room ESV 388 Cafeteria

0103
By 208 S √ √ X1.1 0291
0103
By 209 @ North Stair M √ √ X1.1 0384
0103
By 109 @ North Stair M √ √ XB.1 0135
0103
By 108 S √ √ XB.1 0149
0103
Room 101- Stair Closet RHT √ √ XB.1 0054
0103
Basement Mechanical Room RHT √ √ XB.1 0057
Basement Mechanical Room FS 137 Xavier Basement
Tested By C&H
Basement Mechanical Room SV 136 Xavier Basement
Hall By 103 H √ √ UB 3
0103
Room 103 Right Kitchen N RHT √ √ XB.1 0052
0103
Room 103 Left Kitchen S RHT √ √ XB.1 0057
0103
Office off 103 RHT √ √ XB.1 0050
0103
Storage off 103 RHT √ √ XB.1 0053
0103
Centre Hall/ @ 107 S √ √ XB.1 0055
0103
Room 107 Storage RHT √ √ XB.1 0056
By Women's Washroom H √ √ UB 3
0103
By Exit 14/ Southeast Stair S √ √ XB.1 0058
0103
By Exit 14/ @ Southeast Stair Exit M √ √ XB.1 0139
0103
By 105 S √ √ XB.1 0059

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 16 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

0103
Room 105 Storage RHT √ √ XB.1 0094
0103
Custodial Supplies By 104 RHT √ √ XB.1 0063
0103
Tunnel Entrance off Custodial RHT √ √ XB.1 0064
0103
Custodial Supplies By Pull Station S RHT √ √ XB.1 0060
0103
Exit By 104 SW Stair Exit M √ √ XB.1 0138

Xavier 3rd @ 305- Above Tile DS √ √ X2.1

0103
Custodial at 101 RHT √ √ XB.1 0048

Isolators
Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC S536-04
FIRE ALARM
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham Page 17 of 17

LOCATION DEVICE A B C D E F CODE REMARKS

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Beside Fire Alarm Panel ISO √ √

Tub Across Fire Alarm Panel ISO √ √

Tub Across Fire Alarm Panel ISO √ √

Tub Across Fire Alarm Panel ISO √ √

A- Correctly Installed
B- Requires Service, Repairs, Missing or Cleaning UB Upper Booster
C- Alarm Operation Confirmed LB Lower Booster
D- Annunciation Indication Confirmed
E- Circuit Number or Address
F- Supervision and Ground Fault Detection of Wiring to Device Confirmed
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham

Page 1 of 5

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

1 Top of Stair @ 921 C12-72 (2) PA-6V4.5 (14) 2 13.67 9:40 260
2 Back Hall off 921 C12-72 (2) BB-6V4.5 (13) 2 13.82 9:40 254
3 Sink Room @ 920 C12-72 (2) PA-6V4.5 (13) 6 13.63 9:40 276
4 Back Hall off 919 C12-72 (2) PA-6V4.5 (09) 2 13.69 9:40 328 X See Repairs List
5 Electrical Room off Hall C12-72 (2) PA-6V4.5 (15) 2 13.69 9:40 202
6 Catwalk North C12-72 (2) BB-6V4.5 (11) 4 13.72 9:40 271
7 Catwalk South C12-72 (2) BB-6V4.5 (13) 4 13.81 9:40 262
8 Mechanical Rm East (# 31) 12 MSL 360 PA-1233 (09) 2 13.64 9:40 500 X See Repairs List
9 Mechanical Rm Rear (# 32) 12 MSL 360 PA-1233 (15) 10 13.91 9:40 561 X See Repairs List
10 Fan Room @ 901 Left (#30) 12 MSL 360 PA-1233 (11) 8 13.78 9:40 561
11 Fan Room @ 901 Right (#29) 12 MSL 360 PA-1233 (15) 6 13.62 9:40 499
12 Room 805- Rear Area RG12S72 (2) PA-6V7.2 (15) 4 13.87 9:40 224
13 Room 805- Front Entrance RGC442MT9W 6V7.2 (14) 2 6.79 9:40 287
14 Room 805 Bathroom (Right) RGC442MT9W PA-6V7.2 2 6.87 9:40 281
15 Room 805 Bathroom (Left) RGC442MT9W PA-6V7.2 2 7.01 9:40 291
16 Room 803 RGC442MT9W PA-6V7.2 2 6.93 9:40 289
17 Main Elect. in Denomy (#27) 12 MSL 360 PA-1233 (15) 2 13.49 9:40 743
18 Main Electrical in Denomy (#28) 12 MSL 360 PA-1233 (15) 10 13.57 9:40 528
19 Water Room (Aud. Hall) Left 12 MSL 360 (2) PS-612 (13) 6 13.81 9:40 1211
20 Water Room (Aud. Hall) Right 12 MSL 360 (2) PA-6V12 (11) 10 13.69 9:40 1208
21 Women's W/C (Aud. Hall) C12-72 (2) PA-6V4.5 (12) 2 13.87 9:40 308
22 Men's W/C (Aud. Hall) C12-72 (2) PA-6V4.5 (11) 2 13.92 9:40 262 X See Repairs List
23 Back Stage Left C12-72 (2) PA-6V4.5 (14) 4 13.67 9:40 260
24 Back Stage Left at OH Door C12-72 (2) PA-6V4.5 (13) 2 13.49 9:40 275
25 Stage Right C12-72 (2) PA-6V4.5 (12) 4 13.82 9:40 302
26 Stage Right #22 C12-72 (2) PA-6V4.5 (12) 2 13.73 9:40 315
27 Aud. Left (NW) C12-72 (2) PA-6V4.5 (12) 2 13.61 9:40 310
28 Aud. NW Exit Ramp C12-72 (2) BB-6V4.5 (11) 6 13.69 9:40 202
29 Orchestra Pit S12-160 (2) PA-6V12 (11) 10 13.72 9:40 921

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham

Page 2 of 5

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

30 Auditorium West C12-72 (2) PA-6V4.5 (12) 2 13.89 9:40 284
31 Auditorium South C12-72 (2) PA-6V4.5 (12) 2 13.91 9:40 265
32 Auditorium SE Exit C12-72 (2) PA-6V4.5 (12) 2 13.64 9:40 274
33 Lobby Men's W/C C12-72 (2) PA-6V4.5 (11) 4 13.79 9:40 288
34 Lobby NW C12-72 (2) BB-6V4.5 (14) 2 13.81 9:40 243
35 Lobby SW C12-72 (2) PA-6V4.5 (11) 2 13.87 9:40 258
36 Project Booth C12-72 (2) PA-6V4.5 (13) 2 13.64 9:40 265
37 Lobby Womens W/C C12-72 (2) BB-6V4.5 (10) 3 13.89 9:40 283
38 Hall By Gym SPEX-36 (2) PA-6V4.5 (15) 2 13.93 9:40 249 X See Repairs List
39 Phys-ed Office (Gym) (# 25) 12 MSL 360 PA-1233 (15) 10 13.64 9:40 504 X See Repairs List
40 Phys-ed Office (Gym) (# 26) 12 MSL 360 JC 1233 (15) 10 13.89 9:40 1367
41 Gym Exit to Fitness RG 36 REI PA-6V7.2 (13) 2 6.87 9:40 119
42 Fitness Mechanical Room (# 21) 12 PCH 350 PA-12V33 (07) 14 13.89 9:40 1836 X See Repairs List
43 Fitness Mechanical Room (# 20) RG 36 PA-6V7.2 (09) 4 7.11 9:40 209 X See Repairs List
44 Gym SW Exit RG 36 REI PA-6V7.2 (08) 2 6.79 9:40 400 X See Repairs List
45 Gym SW Exit By Stage HXSW 36 PA-6V7.2 (11) 4 6.87 9:40 410 X See Repairs List
46 Gym SW Exit to Hall HXSW 36 PA-6V7.2 (12) 2 6.91 9:40 478
47 Gym SE Exit to Hall RG 36 REI PA-6V4.5 (15) 2 6.71 9:40 124
48 Gym - Main Hall - Awards SPEX-36 (2) PA-6V4.5 (13) 4 13.69 9:40 233
49 Hall @ Main SE Gym Doors SPEX-36 (2) PA-6V4.5 (12) 2 13.67 9:40 251
50 Hall @ Greenhouse SPEX-36 (2) PA-6V4.5 (12) 2 13.91 9:40 246
51 Hall @ Greenhouse Merici SPEX-36 (2) PA-6V4.5 (08) 2 - 9:40 200 X See Repairs List
52 Hall @ Exit # 9 SPEX-S10720 (2) PA-6V4.5 (11) 4 13.65 9:40 255
53 Hall to Wheelchair Elev. By Exit 9 SPEX-36 (2) PA-6V4.5 (10) 2 - 9:40 200 X See Repairs List
54 Room Between 609/608 (# 19) 12 PCH 350 PA-12V33 (13) 12 13.59 9:40 1873
55 Behind TV & Photocopier RH x3 - X See Repairs List
56 Hall By 601 SPEX-36 (2) BB 6V4.5 (13) 8 13.97 9:40 100 X See Repairs List
57 Wheelchair Access Hall SPEX-36 (2) PA-6V4.5 (13) 4 13.67 9:40 215

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham

Page 3 of 5

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

58 Exit By 603 SPEX-36 (2) PA-6V4.5 (16) 2 13.84 9:40 250
59 Hall @ 503 SPEX-36 (2) BB 6V4.5 (15) 4 13.72 9:40 300
60 Wheelchair Left Hall SPEX-36 (2) PA-6V4.5 (12) 2 13.91 9:40 261
61 Exit By 501 SPEX-36 (2) PA 6V4.5 (09) 4 13.87 9:40 112 X See Repairs List
62 Stairwell to Hall (Ground Level) SPEX-36 (2) PA-6V4.5 (08) 2 13.62 9:40 200 X See Repairs List
63 Hall By 400 Mechanical Room SPEX-36 (2) PA-6V4.5 (13) 4 13.87 9:40 251
64 Electrical Room RGC442MT9W (2) PA-6V7.2 (13) 2 14.01 9:40 264
65 Wheelchair Access Hall SPEX-36 (2) PA 6V4.5 (15) 2 13.91 9:40 268
66 Exit By 403 SPEX-36 (2) PA-6V4.5 (15) 4 13.81 9:40 261
67 Stairs to Staffroom SPEX-36 (2) PA-6V4.5 (11) 2 13.61 9:40 250
68 Exit 8 By Staffroom SPEX-36 (2) PA-6V4.5 (11) 2 13.62 9:40 265
69 Staffroom Exit SPEX-36 (2) PA-6V4.5 (08) 2 13.89 9:40 150 X See Repairs List
70 Bottom of Stair By 310 SPEX-36 (2) PA 6V4.5 (15) 2 13.62 9:40 174
71 Xavier @ Door to Merici SPEX-36 (2) BB 6V4.5 (13) 2 13.81 9:40 246
72 Exit 11 (Near Cafeteria) SPEX-36 (2) PA 6V4.5 (08) 4 13.69 9:40 257 X See Repairs List
73 Exit from Wheelchair Lift Standpro (2) PA-6V4.5 (09) 2 13.82 9:40 267 X See Repairs List
74 Hall By Cafeteria Kitchen SPEX-36 (2) PA 6V4.5 (09) 2 13.61 9:40 320 X See Repairs List
75 Cafeteria Entrance SPEX-36 (2) PA 6V4.5 (09) 2 13.87 9:40 238 X See Repairs List
76 Cafeteria Southwest SPEX-36 (2) PA-6V4.5 (13) 4 13.69 9:40 273
77 Northwest Exit from Cafeteria SPEX-36 (2) PA-6V4.5 (11) 2 13.81 9:40 236
78 Lower Change Room Exit (Girls) SPEX-36 (2) PA-6V4.5 (08) Could Not Test Due To Wet No Access
Wax
79 Lower Change Room Far Exit SPEX-36 (2) BB 6V4.5 (05) No Access

80 Exit # 18 (Stairwell) SPEX-36 (2) PA-6V4.5 (11) 2 13.61 9:40 218

81 Outside Boiler Room- Front SPEX-36 (2) PA-6V4.5 (15) 2 13.71 9:40 100
82 Outside Boiler Room- Front SLC12160 (2) 6V12 (14) 6 13.63 9:40 1377
83 Outside Boiler Room- Rear 8 LMC CSB 6V4.5 (12) 2 13.61 9:40 576
84 By 601 RH x2 - X See Repairs List
85 By Café Exit RHx2 - X See Repairs List

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On) NOTE: Breakers for Units 50-62 in 400 Electrical Room
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham

Page 4 of 5

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

86 Cafeteria Council # 10 Room 12 MSL Insert PA-1233 (15) 10 13.89 9:40 1150
87 Hall By Exit 15 SPEX 36 (2) BB 6V4.5 (09) 2 14.02 9:40 286 X See Repairs List
88 Hall By Sink Room SPEX 36 (2) PA-6V4.5 (13) 2 13.92 9:40 257
89 Stair By Exit #15 Standpro (2) BB 6V4.5 (14) 2 13.94 9:40 297
90 2nd Floor W. Stair to 310 Dance SPEX 36 (2) PA-6V4.5 (14) - 13.97 9:40
91 310- Dance Entrance SPEX 36 (2) PA-6V4.5 (14) 2 13.96 9:40 X See Repairs List
92 Dance Rear Entrance SPEX 36 (2) PA-6V4.5 (14) 2 14.04 9:40 366
93 Dane 310- Exit To Stair SPEX 36 (2) PA-6V4.5 (13) 5 14.01 9:40 102

Xavier Wing
94 Exit @ 301 Magnavolt (2) PA-6V4.5 (15) 2 14.02 10:14 267
95 Wheelchair Elevator Hall SPEX 36 (2) PA-6V4.5 (08) 2 13.98 10:16 361 X See Repairs List
96 Hall By 305 SPEX 36 (2) BB 6V4.5 (09) 2 14.10 10:18 271 X See Repairs List
97 Exit By 304 Magnavolt (2) SLA 6V4.5 (15) 2 13.89 10:20 280
98 Stair Exit to Student Serv. Standpro (2) BB 6V4.5 (13) 2 13.86 10:22 289
99 Student Service Entrance SPEX 36 (2) PA-6V4.5 (12) 2 14.06 10:24 291
100 Student Serv. Entrance-Rear Hall SPEX 36 (2) PA-6V4.5 (11) 2 14.07 10:26 259
101 Student Service Back Hall Exit Standpro (2) PA-6V4.5 (11) 2 13.98 10:28 300
102 Stud. Serv. Back Hall Rear Exit #12 SPEX 36 (2) PA 6V4.5 (12) 2 14.01 10:30 298
103 Exit By 204 SPEX 36 (2) PA 6V4.5 (12) 2 13.96 10:32 260
104 Hall By 205 SPEX 36 (2) PA-6V4.5 (13) 2 13.89 10:34 269
105 Centre Hall Mechanical Room 12 ESL 144 (2) PA-6V12 (12) 2 13.81 10:36 296
106 Hall to Wheelchair Elevator SPEX 36 (2) PA 6V4.5 (12) 2 13.80 10:38 280
107 Exit By 201 SPEX 36 (2) BB 6V4.5 (09) 2 14.06 10:40 260 X See Repairs List
108 Exit By 101 SPEX 36 (2) BB 6V4.5 (13) 2 14.13 10:42 290
109 Exit from Wheelchair Ramp SPEX 36 (2) PA 6V4.5 (09) 2 13.82 10:44 280 X See Repairs List

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

CAN/ULC
EMERGENCY LIGHTING
INDIVIDUAL DEVICE RECORD
Date: July 20th & 21st, 2016

Building Name: Ursuline College Address: 85 Grand Ave West, Chatham

Page 5 of 5

# LOCATION MODEL # BATTERY RH# A B C D REMARKS

110 Bsmt. Centre Hall-Mech. Room #5 12 ESL 144 (2) PA-6V12 (09) - - - - - No Access

111 103 Washroom #8 Student RG 36 PA-6V7.2 (12) 2 6.90 10:48 269

112 103 Washroom Staff RG 36 PA-6V7.2 2 6.78 10:50 260

113 Hall @ 105 SPEX 36 (2) PA 6V4.5 (09) 2 14.08 10:52 295 X See Repairs List
114 Exit # 14 (# 6) RG 36 PA-6V7.2 (11) 2 13.99 10:54 257

115 Exit By 104 SPEX 36 (2) PA-6V4.5 (09) 2 13.94 10:56 287

RH #- Remote Head Count

A- Battery Float Voltage (AC Power On)
B- Test Start Time
C- Battery Charging Current
D- Requires Service, Repairs, Missing
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

EMERGENCY LIGHTING
REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED

1 Back Hall off 919 C12-72 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
2 Mechanical Rm East (# 31) 12 MSL 360 Replaced Battery w/ (1) EnerSys NP33-12 08/24/2016
3 Mechanical Rm Rear (# 32) 12 MSL 360 Replaced Lamp w/ (1) HR-915 12V Wedge Lamp 08/24/2016
4 Men's W/C (Aud. Hall) C12-72 Replaced (2) PA-6V4.5, (1) 12V9W Remote Head 08/24/2016
5 Hall By Gym SPEX-36 Replaced (1) 202T 12V PC Board 08/24/2016
6 Phys-ed Office (Gym) (# 25) 12 MSL 360 Replaced (2) 12V9W Remote Heads, (1) T6 Lamp 08/24/2016
7 Fitness Mechanical Room (# 21) 12 PCH 350 Replaced Battery w/ (1) EnerSys NP33-12 08/24/2016
8 Fitness Mechanical Room (# 20) RG 36 Replaced Battery w/ (1) Panasonic PA-6V12 08/24/2016
9 Gym SW Exit RG 36 REI Replaced Battery w/ (1) PA-6V7.2 & (1) T6-Lamp 08/24/2016
10 Gym SW Exit By Stage HXSW 36 Replaced w/ (1) 6V9W Double Remote Head 08/24/2016
11 Hall @ Greenhouse Merici SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
12 Hall to Wheelchair Elev. By Exit 9 SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
13 Behind TV & Photocopier RH (x3) Replaced Lamps w/ (3) HR-915 12V Wedge Lamp 08/24/2016
14 Hall By 601 SPEX-36 Replaced (1) Stanpro 202T12V PC Board 08/24/2016
15 Exit By 501 SPEX-36 Replaced PA-6V4.5 & (1) 202T 12V PC Board 08/24/2016
16 Stairwell to Hall (Ground Level) SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
17 Staffroom Exit SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
18 Exit 11 (Near Cafeteria) SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
19 Exit from Wheelchair Lift Standpro Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
20 Hall By Cafeteria Kitchen SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
21 Cafeteria Entrance SPEX-36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/24/2016
22 By 601 RH (x2) Re-wired remote heads & installed (2) 12V Double 08/24/2016
Remote Heads
23 By Café Exit # 15 RH (x2) 08/24/2016
24 Hall By Exit 15 SPEX 36 Replaced Board w/ (1) Stanpro 202T 08/24/2016
25 310- Dance Entrance SPEX 36 Replaced w/ (2) PA-6V4.5, (1) 202T 12V PC Bd. 08/24/2016
26 Wheelchair Elevator Hall SPEX 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 09/01/2016

27 Hall By 305 SPEX 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/30/2016

28 Exit By 201 SPEX 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/30/2016

29 Exit from Wheelchair Ramp SPEX 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/30/2016
30 Hall @ 105 SPEX 36 Replaced Batteries w/ (2) Panasonic PA-6V4.5 08/30/2016
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

FIRE ALARM & SPRINKLER SYSTEM/HYDRANT

REPAIRS LIST

REPAIRS
# LOCATION DEVICE REPAIR COMPLETED
Fire Alarm Devices
1 Fire Alarm Booster Booster 1 Replaced Batteries w/ (2) EnerSys NP12-12 08/24/2016
2 Fire Alarm Booster Booster 2 Replaced Batteries w/ (2) EnerSys NP12-12 08/24/2016
3 By 814 H Replaced Device w/ (1) GIR-HD Genesis Horn 08/24/2016
4 Gym SE H Replaced Device w/ (1) GIR-HD Genesis Horn 08/24/2016
5 Hall By Men's W/C H Replaced Device w/ (1) GIR-HD Genesis Horn 08/24/2016

Sprinkler System & (2) Fire Hydrants

All Repairs Completed. See Sprinkler Report 08/24/2016

Additional Comments:
 2018 Mallard Road, Unit #1
London, Ontario N6H 5L8
Phone: (519) 657-2063
Fax: (519) 657-2696

DEVICE LEGEND

DEVICE DESCRIPTION
ANN Annunciator
AD Ancillary Device (Note 4)
B Bell
BZ Buzzer
C Chime
CR Control Relay
CT1 Single Input Module (for supervised Class B signal or audio circuits)
CT2 Double Input Module (for supervised Class B signal or audio circuits)
DH Door Hold Open Device
DS Duct Smoke Detector
ET Emergency Telephone
FACP Fire Alarm Control Panel
FH Firefighters Handset
FS Sprinkler Flow Switch
GA 2nd Stage of 2-Stage Pull Station
H Horn
H/S Horn Strobe
HSP Horn Loudspeaker
HT Heat Detector, Fixed Temperature
HT-RES Resetable Heat Detector
K Horn, Klaxon Type
M Manual Pull Station
MAG LOCK Magnetic Door Lock
PS Pressure Switch
RHT Heat Detector, Rate-of-Rise
S Smoke Detector
SA Smoke Alarm, Single Station Type (Note 3)
SP Loudspeaker
SS Sprinkler Supervisory Switch
SV Sprinkler Valve
TS Sprinkler Tamper Switch (Note 2)
V Visual Alarm Appliance

Note 1: Confirmation of wiring supervision to each individual device is only required during installation verification or a complete building audit
of the system and is not required on the annual test.
Note 2: Sprinkler tamper switches cause trouble condition to be annunciated but not an alarm condition.
Note 3: Single station smoke alarms are not part of the fire alarm system but testing of such devices may be required by the authority
having jurisdiction.
Note 4: Identify the specific ancillary devices in the Remark column of Fire Alarm System Device Test and Inspection Record form
 183 Exeter Road, Unit A
London, Ontario
PHONE (519) 652-5086
FAX (519) 652-8719

Report To: Andersons Electronics Location: Ursuline College

Building Occupancy Type: High School Hazard: Light

Address: 85 Grand Avenue West Inspector: T.Neves
City/Province: Chatham Date: July 22, 2016
Date: Aug. 24, 2016

Where used in this report, N/A means not applicable

Deficiencies involving the issuance of a Certificate Of Compliance will be answered with a “NO” and addressed in section #16

1. GENERAL:

a) Is the building occupied according to information furnished by the owner? YES

b) Is the occupancy the same as the previous inspection according to information supplied by owner? YES
c) Are all systems in service? YES
d) Are all systems the same as the last inspection according to information from the owner? YES
e) Is building completely sprinklered? NO
f) Are all new additions and renovations properly protected? YES
g) Is all storage and stock below sprinkler piping? YES
h) Has the building been free of fires since the last inspection? YES
i) Where there are wet systems, is the building properly heated to prevent the pipes from freezing? YES

2. CONTROL VALVES:

a) Are all main control valves open? YES

b) Are all valves in good condition? YES
c) Are all valves sealed or supervised? SUPERVISED

3. WATER SUPPLIES:

a) Was a flow test done using a 2" drain? YES

b) The static pressure was?
1) System 1 (2nd Floor East) 65 psi
2) System 2 (1st Floor Arts) 65 psi
3) System 3 (2nd Flooor Arts) 65 psi
4) System 4 (Merici Hall) 65 psi
5) System 5 (Xavier) 65 psi
c) The residual pressure was?
1) System 1 (2nd Floor East) 51 psi
2) System 2 (1st Floor Arts) 51 psi
3) System 3 (2nd Floor Arts) 51 psi
4) System 4 (Merici Hall) 51 psi
5) System 5 (Xavier) 51 psi
d) Type of water supply? 6" City Underground

85 Grand Ave Chatham wo#21461 Aug 2016 Insp.xls 1

 4. TANKS, PUMPS & SIAMESE:

a) Are fire pumps, reservoirs and pressure tanks in good condition? YES
b) Pump rating:
psi boost 50
usgpm 100

c) Did fire pump start automatically on a pressure drop? YES

d) Jockey pump cut in pressure: 58
e) Jockey pump cut out pressure: 115
f) Fire pump cut in pressure: N/A
g) Is fire pump properly sized for present application? N/A
h) Is diesel fuel tank full? N/A
i) Were the air compressor tanks drained? N/A
j) Is the diesel engine oil level satisfactory? N/A
k) Is the battery fluid level satisfactory? N/A
l) Is the alternator belt in good condition? N/A
m) Do the pump drain bowls drain properly? N/A
n) Is there a proper bypass and are the valves open? YES
o) Are siamese connections in good condition, couplings free, caps in place and ball drips open? YES
(Brass)
PUMP INFORMATION

a) Pump Manufacturer: S. A. Armstrong

b) Model: 2x2x6 4380
c) Serial #: 108516
d) Pump Capacity USGPM: 100
e) Feet of Head Rating: 115
f) Voltage: 575
g) Phases: 3
h) Motor Speed RPM: 3500 rpm
i) Horse Power: 7.5
j) Controller Manufacturer: Armstrong
k) Model: ENY
l) Serial #: ES-10315
m) Type of Pump: Electric

5. FIRE HYDRANTS:

a) Was the hydrant valve found? YES

b) Was the hydrant valve open? YES
c) Did the fire hydrant open & operate properly? YES
d) Was the bonnet “O ” ring lubricated? YES
e) Were the outlet caps in place and tight? YES
f) Was water flowed from the hydrant? YES
g) Did the water drain from the barrel properly? YES
h) Was a flow test done? YES
Hydrant #1 -Middle of Parking Lot
i) The static pressure was? 62
k) The pitot reading from an engineered playpipe was 40 Using an outlet size of 2.5
l) The USGPM results are? 1061
Hydrant #2 -In front of School
i) The static pressure was? 62
k) The pitot reading from an engineered playpipe was 30 Using an outlet size of 2.5
l) The USGPM results are? 919

85 Grand Ave Chatham wo#21461 Aug 2016 Insp.xls 2

 6. WET SYSTEMS:

# of wet systems: FIVE Make & Model: 2- VIC 4"

2- CSC 4"
1 - TYCO 4"

a) Are alarm valves in good condition? YES

b) Are flow switches working and in good condition? YES
c) Are tamper switches working and in good condition? YES
d) Is the excess pressure pump functional? YES
e) Is the valve trimmed properly? YES
f) The operation of the excess pressure pump is? MANUAL
g)The excess pressure pump automatically starts at? N/A
Air pressure at trip time n/a n/a
Trip point air pressure n/a n/a
Trip time to open clapper n/a n/a
a) Has anti-freeze solution been checked?
b) Is system in service?
c) What temperature is the anti-freeze solution rated for?
N/A
a) Were deluge and/or pre-action valves tested as required?
b) Were all H.A.D.s tested?
c) Were supervisory systems tested satisfactorily?

10. STANDPIPE SYSTEMS:

a) Is building equipped with a standpipe system? YES

b) Is standpipe wet or dry? WET
c) Are the standpipe hoses connected to the sprinkler system or on a separate system? SPRINKLER
d) Are all nozzles, hoses, glass, valves and stops in place? NO (by others)
e) Have the hoses been re-racked at time of inspection? NO (by others)
f) Were the hoses hydrostatically tested? NO (by others)
g) Was a flow test performed on the standpipe system ? Yes
h) The static pressure was? 125psi
i) The residual pressure was? 107psi
j) The pitot reading from an engineered playpipe was 26 Using an outlet size of 1-1/2"
k) The USGPM results are? 308

11. ALARMS:

a) Did the water motor gong test satisfactorily? YES

b) Did the electric alarm test satisfactorily? YES
c) Did the supervisory alarms test satisfactorily? YES
d) The low pressure switch sends a low pressure warning at?
1) System 1 101 psi
2) System 2 102 psi
3) System 3 105 psi
4) System 4 101 psi
5) System 5 105 psi

12. SPRINKLERS & PIPING:

a) Are all sprinklers in good condition, free from obstruction, corrosion and loading? YES
b) Are the sprinklers less than 50 years old? (2002) YES
c) Are there spare sprinklers and a wrench in the head cabinet? YES
d) Is the condition of the piping, drain valves, hangers and gauges in good condition? YES
e) Have the sprinklers been checked for the proper temperature rating? YES

85 Grand Ave Chatham wo#21461 Aug 2016 Insp.xls 3

 13. CONTROL VALVES & DEVICE LIST:

Zone or Location Device Supplies Condition

Valve Room 4" Butterfly Valve Main Central Valve Operational
Valve Room 4" Vic Butterfly Intake Fire Pump Standpipe Operational
Valve Room 4" Vic Butterfly Discharge Fire Pump Standpipe Operational
Valve Room 4" OS&Y Valve Intake Backflow Operational
Valve Room 4" OS&Y Valve Discharge Backflow Operational
Valve Room 4" Amos Backflow (4-DCA) Standpipe Operational
Valve Room Social NO > Q926f11 ? Standpipe Operational
Valve Room 4" Butterfly (Fivalzo Inc) ? Ground Floor East Operational
Valve Room PS10 - 1A (Flow Switch) Ground Floor East Flow Operational
Valve Room PS120 - 1A (Pressure Switch) Ground Floor East Low Pressure Operational
Valve Room 4" Alarm Valve Tyco Ground Floor East Operational
Valve Room 4" Vic Butterfly 1st Floor Arts Operational
Valve Room PS10-1A (Flow Switch) 1st Floor Arts Low Flow Operational
Valve Room PS120-1A (Pressure Switch) 1st Floor Arts Low Pressure Operational
Valve Room 4" Vic Alarm Valve 1st Floor Arts Operational
Valve Room PS10-1A (Flow Switch) 2nd Floor Arts Flow Operational
Valve Room PS120-1A (Pressure Switch) 2nd Floor Arts Low Pressure Operational
Valve Room 4" Vic Alarm Valve 2nd Floor Arts Operational
Valve Room Ps120 - 1A (Pressure Switch) Ground Floor East Low Pressure Operational
Mechanical Room (Fitness) 4" Butterfly Valve Merici Hall Main Control Operational
Mechanical Room (Fitness) 4" Alarm Valve (CSC) Merici Hall Operational
Mechanical Room (Fitness) PS10-1A (Flow Switch) Merici Hall Flow Operational
Mechanical Room (Fitness) PS120-1A (Pressure Switch) Merici Hall Low Pressure Operational
Mechanical Room (Fitness) 4" Butterfly Valve Xavier Hall Main Control Operational
Mechanical Room (Fitness) 4" Main Valve (CSC) Xavier Hall Operational
Mechanical Room (Fitness) PSS-120 (Pressure Switch) Xavier Hall Low Pressure Operational
Mechanical Room (Fitness) WFS-5 (Flow Switch) Xavier Hall Flow Operational
Mechanical Room (Fitness) VSR-F Paddle Flow 4" Xavier Hall 1st Floor Flow Operational
Mechanical Room (Fitness) 4" Butterfly Valve Xavier Hall Zone Control 1st Floor Operational
Mechanical Room (Fitness) VSR-F Paddle Flow 2" Greenhouse Flow Operational
Mechanical Room (Fitness) 2" Butterfly Valve Greenhouse Zone Control Operational
Mechanical Room (Fitness) 3" Butterfly Valve Merici Hall Zone Control 1st Floor Operational
Mechanical Room (Fitness) 3" VSR-F Paddle Flow 3" Merici Hall 1st Floor Operational
Mechanical Room (Fitness) 3" Butterfly Valve Merici Hall 2nd Floor Zone Control Operational
Mechanical Room (Fitness) 3" VSR-F Paddle Flow Merici Hall 2nd Floor Operational
2nd Floor Mechanical Room 4" Butterfly Valve Xavier Hall Ground Floor Zone Control Operational
2nd Floor Mechanical Room 4" VSR-F Paddle Flow Xavier Hall Ground Floor Flow Operational
Grd Flr Mechanical Room 3" Butterfly Valve Cafe Zone Control Operational
Grd Flr Mechanical Room 3" VSR-F Paddle Flow Cafe Flow Operational
Basement Mechanical Room 4" Butterfly Valve Xavier Zone Control Operational
Basement Mechanical Room 4" VSR-F Paddle Flow Xavier Flow Operational
Gdn Flr Mech. Rm. 4" Butterfly Valve Xavier Flow Operational
Gdn Flr Mech. Rm. 4" VSR-F Paddle Flow Xavier Flow Operational

85 Grand Ave Chatham wo#21461 Aug 2016 Insp.xls 4

 14. Listed are recent changes in the building occupancy or fire protection equipment.

NONE

15. The following are corrections made at the time of inspection.

NONE

16. DEFICIENT ITEMS:

*Low pressure switch failed. **Requires replacement. Replaced Aug. 24, 2016

The above items are deficient as per The Ontario Fire Code and need to be corrected immediately.
A certificate of inspection cannot be issued until all items under section #16 have been addressed.
Consultation with the local fire prevention office is suggested, if discrepancies occur

17. The following items are recommendations only.

NONE

• LIMITATION OF LIABILITY: It is understood and agreed that the INSPECTOR is NOT an insurer and is NOT warranting or
guaranteeing the adequacy, performance or life expectancy of any structure, item, component or system in the building. Further, it is
mutually agreed that the maximum amount of joint and several liability the INSPECTOR can incur for any error, mistakes, omissions,
breach of contract, breach of warrantee, negligent hiring, or any other theory of liability including violation of a statute or consumer
protection act is strictly limited to the FEE PAID for the inspection report.

NOTE: This inspection/test was performed in accordance with The Ontario Fire Code. This inspection does NOT certify that the sprinkler
system installation complies with NFPA, OBC or Ontario Retrofit Reg. #627/92 (an engineer’s report would be required to certify this).

As per the requirements of The Ontario Fire Codes, the inspecting company must submit this report to the local Fire Prevention office

85 Grand Ave Chatham wo#21461 Aug 2016 Insp.xls 5

 ANNUAL FIRE ALARM SYSTEM TESTING CERTIFICATE

DATE OF INSPECTION: July 21st, 2016

PROPERTY OWNED/MANAGED BY: ST. CLAIR CATHOLIC DISTRICT SCHOOL BOARD

THIS DOCUMENT CERTIFIES THAT THE FIRE ALARM SYSTEM AT THE FOLLOWING LOCATION;
URSULINE COLLEGE~ 85 GRAND AVENUE WEST, CHATHAM
HAS BEEN TESTED & INSPECTED IN ACCORDANCE WITH THE STANDARD FOR THE INSPECTION AND TESTING OF
FIRE ALARM SYSTEMS, CAN/ULC-S536-04. THE SPRINKLER SYSTEM & FIRE HYDRANT HAVE ALSO BEEN INSPECTED
AT THIS LOCATION.

A TEST OF ALL EMERGENCY LIGHTING EQUIPMENT WAS ALSO COMPLETED IN ACCORDANCE WITH CANADIAN
ULC CODES AND DESIGN CRITERIA DESIGNATED BY MANUFACTURER'S SPECIFICATIONS.

TESTING TECH.: Kevin Bury CONFIRMED BY: Jim Anderson

CFAA #: 19-995199
FA. REP'S TECH: Alban Berisha DATED: September 1st, 2016
CFAA #: 19-996582