Fire Sprinkler & Standpipe Inspection Report for UMMS Shore Medical Pavilion

• Monthly Fire Sprinkler & Standpipe 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 25 (2014) Chapter 13, for visual inspections of fire sprinkler and standpipe components. 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 sprinkler service vendor:

Monthly Inspection

• Valves

• 1) Control valves are in their normal open position?

  Yes

  No

  N/A

• 2) Alarm valves and test valves are in their normal closed position?

  Yes

  No

  N/A

• 3) Control valves are locked in the open position or are electronically supervised?

  Yes

  No

  N/A

• 4) Valves are free of leaks or damage?

  Yes

  No

  N/A

• 5) Valves are marked with appropriate identification sign?

  Yes

  No

  N/A

• Gauges

• 1) Gauges show normal water pressures?

  Yes

  No

  N/A

• 2) Gauges are free of leaks or damage?

  Yes

  No

  N/A

• Record notes here.

• Add 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