Fire Alarm Inspection Report for UMMS Shore Medical Pavilion

• Weekly/Monthly Fire Alarm Inspection Report

• Document No.

• UMMS Shore Medical Pavilion

• 125 Shore Way Drive
  Address

• Conducted on

  Date

• Inspection Template Prepared by:

• Personnel

General Information

• Information on this form covers the minimum requirements of NFPA 72 (2013), Table 14.3.1 for visual inspections of fire alarms. Separate forms are available to inspect, test and maintain the rest of the fire protection system of which the fire alarm is a part.

• UMMS Shore Medical Building

• Ralph Lindner

  Ted Sacra

  Dan Thomas

  Anthony Carter

• Date of Inspection:

  Date

• All responses refer to the current inspection performed on this date.

• Fire alarm service vendor:

• Fire alarm monitoring vendor:

Weekly Fire Alarm Inspection

• Date of weekly inspection.

  Date

• Control Equipment

• 1) Fire alarm is powered?

  Yes

  No

  N/A

• 2) Fire alarm control panel and remote enunciator panels are unobstructed and accessible by emergency personnel?

  Yes

  No

  N/A

• 3) Lights and LEDs light when tested?

  Yes

  No

  N/A

• 4) Control panel is free of supervisory or trouble signals?

  Yes

  No

  N/A

• Record notes here.

• Include photos here if necessary.

  Media

Monthly Fire Alarm Inspection

• Date of monthly inspection.

  Date

• 1) Batteries are free of corrosion and leakage?

  Yes

  No

  N/A

• 2) Battery connections are tight?

  Yes

  No

  N/A

• Date on battery is less than 5 years old?

  Yes

  No

  N/A

• Record notes here.

• Include photos here if necessary.

  Media

Inspector's Information

• Company: Colliers International

• I state that the information on this form is correct at the time and place of inspection, and that all equipment tested at this time was left in operational condition upon completion of this inspection.

• Add signature

  Sign

• Select date

  Date