COLDWATER FIRE DEPARTMENT FIRE SUPPRESSION SYSTEM INSPECTION REPORT - duplicate

BUSINESS NAME:

BUSINESS ADDRESS:

BUSINESS OWNER / CONTACT:

TELEPHONE NUMBER:

EMAIL ADDRESS:

• DATE & TIME OF INSPECTION

  Date

CONTRACTING FIRM / SERVICE PROVIDER:

COMPANY CONTACT - PHONE - EMAIL ADDRESS:

TYPE OF INSPECTION:

• WHAT TYPE OF INSPECTION?

  Select ACCEPTANCE RE-ACCEPTANCE ADDED EQUIPMENT

  • ACCEPTANCE
  • RE-ACCEPTANCE
  • ADDED EQUIPMENT

OCCUPANCY TYPE:

• OCCUPANCY USE?

  Select BUSINESS INDUSTRIAL MERCANTILE ASSEMBLY STORAGE APARTMENT/RENTAL HOTEL EDUCATIONAL STATE FACILITY

  • BUSINESS
  • INDUSTRIAL
  • MERCANTILE
  • ASSEMBLY
  • STORAGE
  • APARTMENT/RENTAL
  • HOTEL
  • EDUCATIONAL
  • STATE FACILITY

SYSTEM TYPE:

• WHAT TYPE OF SYSTEM INSPECTED?

  Select WET DRY FOAM PRE-ACTION / INTERLOCK DELUGE

  • WET
  • DRY
  • FOAM
  • PRE-ACTION / INTERLOCK
  • DELUGE

SPECIAL HAZARD TYPE:

• SPECIAL HAZARD SYSTEM TYPE?

  Select APPROVED HALON CO2 DRY CHEMICAL WATER MIST OTHER N/A

  • APPROVED HALON
  • CO2
  • DRY CHEMICAL
  • WATER MIST
  • OTHER
  • N/A

GENERAL DATA:

• UNDERGROUND WATER SUPPLY TESTED BY:

  Select CBPU QUALIFIED OTHER

  • CBPU
  • QUALIFIED OTHER

• PLAN REVIEWED BY?

  Select CFD STATE BUREAU NOT REVIEWED

  • CFD
  • STATE BUREAU
  • NOT REVIEWED

• NUMBER OF SYSTEMS?

  1 to 5

  5 to 10

  10 +

  N/A

• NUMBER OF SYSTEM RISERS?

  1 to 5

  5 to 10

  10 +

  N/A

• AREA OF PROTECTION?

  TOTAL COVERAGE

  KITCHEN HOODS

  LIMITED AREA

HYDRAULIC NAMEPLATE DATA:

FIRE SPRINKLER TESTING:

• HYDROSTATIC PRESSURE TESTING STATUS?

  PASSED

  FAILED

  N/A

• MAIN DRAIN TESTING STATUS?

  PASSED

  FAILED

  N/A

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• DRY VALVE TRIP TEST STATUS?

  PASSED

  FAILED

  N/A

• LOW AIR ALARM TEST STATUS?

  PASSED

  FAILED

  N/A

• TIME FOR WATER OR NFPA 13 EXEMPTION?

  PASSED

  FAILED

  N/A

• FIRE PUMP TESTING STATUS?

  PASSED

  FAILED

  N/A

• FIRE PUMP TESTING DOCUMENTS PROVIDED.

  Yes

  No

  N/A

• JOCKEY PUMP TESTING STATUS.

  PASSED

  FAILED

  N/A

• FIRE PUMP CONTROLLER TESTING STATUS?

  PASSED

  FAILED

  N/A

• SPRINKLER POSITION - SPACING - OBSTRUCTIONS?

  PASSED

  FAILED

  N/A

• SPRINKLER PIPING STATUS?

  PASSED

  FAILED

  N/A

• RISER VALVES OR FDC OBSTRUCTIONS?

  Yes

  No

  N/A

• ALL SYSTEMS RETURNED TO SERVICE?

  Yes

  No

  N/A

SPECIAL HAZARD SYSTEM TESTING:

• CONTROLLER TESTING STATUS?

  PASSED

  FAILED

  N/A

• SYSTEM PIPING STATUS?

  Yes

  No

  N/A

• NOZZLE TESTING STATUS?

  PASSED

  FAILED

  N/A

• MANUAL ACTIVATION TESTING STATUS?

  PASSED

  FAILED

  N/A

• DETECTOR/AUTOMATIC TESTING STATUS?

  PASSED

  FAILED

  N/A

• CONTAINER PRESSURE & TYPE STATUS

  PASSED

  FAILED

  N/A

• AIR TESTING STATUS?

  PASSED

  FAILED

  N/A

• ROOM PRESSURE TESTING STATUS?

  PASSED

  FAILED

  N/A

• ABORT FUNCTIONING STATUS?

  PASSED

  FAILED

  N/A

• PRE-SIGNAL STATUS?

  PASSED

  FAILED

  N/A

• PRIMARY & SECONDARY POWER STATUS?

  PASSED

  FAILED

  N/A

• DUMP TEST COMPLETED?

  Yes

  No

  N/A

• SYSTEM RETURNED TO SERVICE?

  Yes

  No

  N/A

HOOD SUPPRESSION SYSTEM TESTING:

• IS SYSTEM UL - 300 COMPLIANT?

  Yes

  No

  N/A

• CYLINDERS COMPLIANT?

  Yes

  No

  N/A

• PUFF TESTING COMPLETED?

  Yes

  No

  N/A

• SYSTEM VISUAL OR AUDIBLE ALARM PRESENT?

  Yes

  No

  N/A

• BUILDING FIRE ALARM INTERFACE?

  Yes

  No

  N/A

• FUEL SUPPLY SHUT OFF?

  Yes

  No

  N/A

• EXHAUST AIR CONTINUE RUNNING?

  Yes

  No

  N/A

• ALL POWER UNDER THE HOOD SHUT DOWN?

  Yes

  No

  N/A

• SYSTEM RETURNED TO SERVICE?

  Yes

  No

  N/A

• ANNUAL MAINTENANCE PROGRAM IN PLACE?

  Yes

  No

  N/A

• FINAL SYSTEM TESTING STATUS

  PASSED

  FAILED

  N/A

DEFICIENCY ISSUES & REINSPECTION ITEMS:

REINSPECTION INFORMATION:

• REINSPECTION NEEDED?

  Yes

  No

  N/A

• REINSPECTION DATE & TIME

  Date

• INSPECTOR:

  Sign