Annual Sprinkler and Standpipe Inspection Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Inspection Information

• Inspection Address:
  Address

• Date of Inspection:

  Date

• Date Inspection Completed:

  Date

• Inspection Completed by:

• Inspector Signature:

  Sign

Central Supervision

• Central Supervision Panel?

• Type of Panel:

• Central Monitoring Company?

• Central Monitoring Company:

• Phone Number:

• Account and Password:

• Fire alarm test in conjunction with this inspection?

• Did it pass/fail?

  Pass

  Fail

Device Information

Fire Department Connections

• Fire Department Connection:

  Yes

  No

• Quantity of Fire Deparment Connections:

• Size of Fire Department Connection:

• FD caps present?

  Yes

  No

• Number and Type of Caps to be Ordered:

Incoming Water, Fire Pumps, and Backflow Preventers

• Size of incoming water:

• Is the incoming water room / sprinkler room adequately heated

  Yes

  No

  N/A

• Is there more than one sprinkler valve room?

  Yes

  No

• How many sprinkler valve rooms are there?

• Are all the sprinkler valve rooms adequately heated?

  Yes

  No

  N/A

• Is there a fire pump?

  Yes

  No

• What is the make and model of the fire pump?

• Jockey pump cut in pressure?

• Jockey pump cut out pressure?

Backflow Prevention Device(s)

• What is the Make and Model of backflow preventer on the fire sprinkler system?

• What is the size?

• Who last tested the backflow preventer?

• When was it last tested?

  Date

• Did the device pass the last test?

  Yes

  No

• Are the valves left in proper working condition at the end of the inspection?

  Yes

  No

  Yes, Sealed.

  No, not Sealed

• Explanation:

• PIcture of Issue:

  Media

• Is there more than one backflow preventer on the sprinkler system?

  Yes

  No

• Types of backflow prevention devices:

Backflow Prevention Device

• What is the type of the backflow preventor?

  DCVA

  RP DCVA

• What is the size of the device?

• What is the model of the device?

• Who last tested the device?

• When was the device last tested?

  Date

• Did the device pass the last test?

  Yes

  No

• Are the valves left in proper working position at the end of inspection?

  Yes

  No

  Yes, Sealed.

  No, not Sealed

• Explanation:

• PIcture of Issue:

  Media

Sprinkler Systems

• Is there a Standpipe system ?

  Yes

  No

• What is the size?

• What is the approx. height?

• What is the pressure at the top (psi)?

• Is there a Wet System Alarm valve?

  Yes

  No

• Who is the manufacturer?

• What is the Model?

• What is the size?

• Is there a flow switch?

  Yes

  No

• Who is the manufacturer of the flow switch?

• What is the model of the flow switch?

• Is there an Excess Pressure Pump?

  Yes

  No

• Manual or Auto?

  Manual

  Auto

• What is the cut in pressure (psi)?

• What is the cut out pressure (psi)?

• Is there a Dry System?

  Yes

  No

• Who is the manufacturer?

• What is the size?

• What is the model?

• Is there more than one Dry Pipe system?

  Yes

  No

• Is there a Glycol System?

  Yes

  No

• What is the size of the system?

• How many heads are on the system?

• What is the type and rating of the sprinkler heads?

• Who is the manufacturer of the sprinkler heads?

• What is the temperature of the glycol tested for?

• Was the glycol tested during the inspection?

  Yes

  No

• Is there a Pre-Action system?

  Yes

  No

• Where is the system located?

• Who is the manufacturer of the pre-action system?

• What is the size of the pre-action system?

Supervisory Devices

• Total Number of Flow Switches:

• Total Number of Pressure Switches:

• Total Number of Tamper Switches:

• Water Motor Gong

  Off

  On

• Did the Water Motor Gong Function properly?

  Fully Operational

  Poor Operation

  Inoperable

Reserve Sprinkler Heads

• Reserve Head Box?

  Yes

  No

• Head Wrench Present

  Yes

  No

• What type of head wrench(es) should be ordered?

• Are there sufficient number of spare sprinkler heads for each type req'd on site?

  Yes

  No

• What type of sprinkler heads are present?

• Picture of Reserve Heads

  Media

• What type and amount of sprinkler heads should be ordered?

• Picture of Types of Heads Req'd:

  Media

Water Pressure - Static and Residual

• From NFPA 13: The proper method of conducting this test is to use two hydrants in the vicinity of the property. The static pressure should be measured on the hydrant in front of or nearest to the property and the water allowed to flow from the hydrant next nearest the property, preferably the one farthest from the source of supply if the main is fed only one way. The residual pressure will be that indicated at the hydrant where water is not flowing.
  
  EX Take a fire hydrant and take the static pressure, say 80 psig. Open an adjacent hydrant. Take the static pressure again at the 1st hydrant. Say it now reads 50 psi. That is your residual pressure.

• Static Water Pressure (psi):

• Residual Water Pressure (PSI) Measured:

  Yes

  No

• Residual Water Pressure (PSI):

Fire Alarm Inspection Record

• Date of Inspection:

  Date
• Address of Inspection:
  Address

• TS - Tamper Switch FS - Flow Switch APS - Alarm Pressure Switch PS - Pressure Switch Micro - Micro Switch GV - Gate Valve BF - Butterfly Valve WG - Water Motor Gong

• Location

• System / Zone:

• Device:

  Select Tamper Switch Flow Switch Alarm Pressure Switch Pressure Switch Micro Switch Gate Valve Butterfly Valve Water Motor Gong

  • Tamper Switch
  • Flow Switch
  • Alarm Pressure Switch
  • Pressure Switch
  • Micro Switch
  • Gate Valve
  • Butterfly Valve
  • Water Motor Gong

• Functions:

  Yes

  No

• Remarks

• Functions:

  Yes

  No

• Time (sec):

• Remarks:

• Yes

  No

• Remarks:

• Yes

  No

• Cut Out Pressure:

• Cut In Pressure:

• Low Air Alarm

• Remarks:

• Functions:Rem

  Yes

  No

• Remarks:

• Functions:

  Yes

  No

• Remarks:

• Functions:

  Yes

  No

• Remarks:

• Functions:

  Yes

  No

• Remarks:

Deficiency Report

Item:

• Description:

• Add media

  Media

• Comments / Material Req'd: