Fire Protection Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Fire Protection Survey Information

• Location of survey

  Select Baylor - Aubrey Baptist - Thousand Oaks Baptist - Westover Hills Baptist - Overlook Baptist - Hausman Baptist - Schertz Emerus - Sugarland Emerus - Tomball

  • Baylor - Aubrey
  • Baptist - Thousand Oaks
  • Baptist - Westover Hills
  • Baptist - Overlook
  • Baptist - Hausman
  • Baptist - Schertz
  • Emerus - Sugarland
  • Emerus - Tomball

• Surveyor

• Surveyor's Title

• Surveyor's Signature

  Sign

• On Site Representative

• On Site Representative's Title

• On Site Representative's Signature

  Sign

2. Fire Alarm System - Monthly [NFPA 72: 7-1.1.1]

• Was the system placed on test mode with the central monitoring company prior to the test?

  Yes

  No

  N/A

• What method was used for the manual test

  Activated a manual pull station

  Water flow test (inspector's valve)

• Was the test successful locally

  Yes

  No

  N/A

• Was the test acknowledged by the central monitoring company

  Yes

  No

  N/A

• Was the system placed back on an active status

  Yes

  No

  N/A

3. Fire Alarm System - Quarterly Supervisory Signal Devices [ NFPA 72: 7-3.2 and Table 7-3.2(15)(j)]

• Was the system placed on test mode with the central monitoring company prior to the test?

  Yes

  No

  N/A

• What method was used for the quarterly test

  Activated the tamper controls on the fire riser

  Disconnected the fire alarm control battery

  Disconnected a smoke detection device

• Was the test successful locally

  Yes

  No

  N/A

• Was the test acknowledged by the central monitoring company

  Yes

  No

  N/A

• Was the system placed back on an active status

  Yes

  No

  N/A

4. Fire Alarm - Semi Annual

• Was the system placed on test mode with the central monitoring company prior to the test?

  Yes

  No

  N/A

• Have all visible components of the fire alarm system been inspected [NFPA 72: 7-3.1 and Table 7-3.1]?

  Yes

  No

  N/A

• Was the water flow test successfully triggered locally [NFPA 72: 7-3.2 and Table 7-3.2(15)(k)]

  Yes

  No

  N/A

• Was the tamper switch successfully triggered locally [NFPA 72: 7-3.2 and Table 7-3.2(15)(l)]

  Yes

  No

  N/A

• Was the system placed back on an active status

  Yes

  No

  N/A

• Was the test acknowledged by the central monitoring company

  Yes

  No

  N/A

5. Fire Alarm - Annual

• Date of the last annual inspection

  Date

• Alarm testing company

• Has the fire alarm system components been inspected [NFPA 72: 7-3.2 and Table 7-3.2]

  Yes

  No

  N/A

• Has the battery charger been inspected [NFPA 72: 7-3.2 and Table 7-3.2(6)]

  Yes

  No

  N/A

• Has the duct detectors been inspected [NFPA 72: 7-3.2 and Table 7-3.2(15)(a)]

  Yes

  No

  N/A

• Has the electromechanical releasing devices been inspected [NFPA 72: 7-3.2 and Table 7-3.2(15)(b)]

  Yes

  No

  N/A

• Has the inspection been clearly noted in the main fire control panel

  Yes

  No

  N/A

• Has notice of the inspection been filed in the hospital logs

  Yes

  No

  N/A

• Are there any deficiencies or recommended service items noted

  Yes

  No

  N/A

6. Fire Suppression System - Inspected at Least Annually from the Floor [NFPA 25: 5-2.1.1]

• Type of suppression system

  Wet

  Dry

  Pre-Action

  Combined

• Fire suppression system service company

• Date of last inspection (marked at the main riser)

  Date

• Is the system free of deficiencies (marked at the main riser)

  Yes

  No

  N/A

• Is the sprinkler control room free of obstructions and clearly labeled

  Yes

  No

  N/A

• Are all sprinkler heads free and clear of obstructions

  Yes

  No

  N/A

• Is the system free and clear of any visible deficiencies

  Yes

  No

  N/A

7. Fire Extinguishers - Must be Inspected on 30 day Intervals [NFPA 10: 6.2.1]

• Fire extinguisher service company

• Date of last inspection

  Date

• Size of exinguishers

• Type of extinguishers

• Quantity of extinguishers

• Are the monthly inspection logs current on each extinguisher

  Yes

  No

  N/A

• Are the extinguishers properly mounted and secured

  Yes

  No

  N/A

• Are the extinguishers accessible and properly labeled

  Yes

  No

  N/A

• Are all of the extinguishers functional and without need of service

  Yes

  No

  N/A

Corrective Actions / Comments

• Enter any corrective actions or comments needed