FIRE SPRINKLER INSPECTION REPORT

• Client/Site Name

• CLIENT/SITE ADDRESS

• Location
  Address

• CUSTOMER POINT OF CONTACT

• Service Trade #

• NELBUD SERVICES
  51 KOWEBA LANE
  INDIANAPOLIS, IN 46201
  855-NELBUD-9
  NELBUD.com

• Inspector

• Date & Time of Inspection

  Date

1. GENERAL

• a. Have there been any changes in the occupancy classification, machinery or operations since the last inspection?

  Yes

  No

  N/A

• b. Have there been any changes or repairs to the fire protection systems since the last inspection? <br>(If answered “Yes” to questions 1 or 2, list changes in comments)

  Yes

  No

  N/A

• c. If a fire has occurred since the last inspection, have all damaged sprinkler system components been replaced?

  Yes

  No

  N/A

• d. Has the piping in all dry systems been checked for proper pitch within the past five years?

  Yes

  No

  N/A

• e. Has the piping in all systems been checked for obstructive materials? (Recommended every 5 years)

• e1. Date piping in all systems was checked for obstructive materials?

• f. Have Fire Pump(s) been tested to their full capacity through hose streams or flow meters, within the last 12 months?

  Yes

  No

  N/A

• g. Are gravity, surface or pressure tanks protected from freezing?

  Yes

  No

  N/A

• h. Standard sprinklers 50 years or older? QR Heads: 20 years, Dry Pendents: 10 years, Extra High Temperature: 5 years<br>(Testing or replacement is recommended for such sprinklers)

  Yes

  No

  N/A

• i. Are any extra high temperature solder Sprinklers regularly exposed to temperatures near 300F?

  Yes

  No

  N/A

• j. Have Gauges been tested or replaced in the last 5 years?

  Date

• k. Have check valves been internally inspected in the last 5 years?

  Date

• l. Has the Private Main (Hydrant) been flow tested in the last 5 years?

  Date

• B. (To be answered by the Inspector)

• a. Have the sprinkler systems been extended to all visible areas of the building?

  Yes

  No

  N/A

• b. Is there proper clearance between the top of all storage and the sprinkler heads?

  Yes

  No

  N/A

• c. Are areas which are protected by a wet system, heated, including blind attics and perimeter areas?

  Yes

  No

  N/A

• d. Are all exterior openings protected against the entrance of cold air?

  Yes

  No

  N/A

2. CONTROL VALVES

• City Connection Valves

• City connection valve type

  Select PIV OSY Butterfly City street valve

  • PIV
  • OSY
  • Butterfly
  • City street valve

• City connection valve(s)

  Media

• Backflow Model(s) And Size(s) on Fire Line

• Number of Fire Pump Valves

• Fire Pump Valve Manufacturer, Model, GPM

• Number of Sectional Valves (Isolation Valves in stairwells etc.)

• Sectional Valve Type(s)

• Number of System Valves

• System Valve Type(s)

• Number of Alarm Lines (typically on Dry Alarm Valves and Wet Alarm Valves)

• Alarm Line Valve Type(s)

• Where in the building are inspectors test valves and low point valves located?

3. WATER SUPPLIES

• a. What is the water supply source?

  City Supply

  Gravity Tank

  Fire Pump & City Supply

  Fire Pump & Gravity Tank

  Fire Pump & Pond

• What is the Static Water Pressure?

• What is the Residual Water Pressure?

• After water flow, what is the Static Water Pressure?

4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS

• a. Do fire pumps, gravity, surface or pressure tanks appear to be in good external condition?

  Yes

  No

  N/A

• b. Are gravity, surface and pressure tanks at proper pressure and/or water levels?

  Yes

  No

  N/A

• c. Has the storage tank been internally inspected in the last 5 years?

  Yes

  No

  N/A

• d. Are the fire dept. connections in satisfactory conditions, couplings free, caps or plugs in place and check valves tight?

  Yes

  No

  N/A

• e. Are fire dept. connections visible and accessible?

  Yes

  No

  N/A

5. WET SYSTEMS

• a. How many wet systems are present?

• Wet System Make & Model

• Wet systems

  Media

• b. Are cold weather valves in appropriate open or closed position?

  Yes

  No

  N/A

• c. Has the owner or owners representative been advised that cold weather valves are not recommended by NFPA?

  Yes

  No

  N/A

• d. Are any Antifreeze systems present?

  Yes

  No

  N/A

• e. When were any antifreeze systems last tested?

  Date

• f. What degrees the antifreeze currently protect to?

• g. Did the alarm valves, water flow alarm indicators and retards test satisfactorily?

  Yes

  No

  N/A

6. DRY SYSTEMS

• a. How many dry systems are present?

• Dry System Make & Model

• Dry system(s)

  Media

• Date of last Full Dry System Trip

  Date

• Choose one below

• Today, conducted full dry system trip

• Today, conducted partial dry system trip

• a1. Dry system air pressure?

• a2. Dry system air pressure trip point?

• a3. Dry system trip time

• a4. How long did it take water to reach the inspectors test?

• a5. How many low points are on this dry system?

• b. Are air and priming water levels normal?

  Yes

  No

  N/A

• c. Did the air compressor operate satisfactorily?

  Yes

  No

  N/A

• d. Were air compressor oil & belt checked and tank drained?<br>

  Yes

  No

  N/A

• e. Were all low points drained in preparation for cold temperatures?

  Yes

  No

  N/A

• f. Is the Dry System protected from freezing with adequate heat?

  Yes

  No

  N/A

7. SPECIAL SYSTEMS

• a. How many special systems are present?

• What type of special system(s) is present?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• b. Were systems tested as required?

  Yes

  No

  N/A

• c. Did all heat responsive systems operate satisfactorily?

  Yes

  No

  N/A

• d. Did all supervisory features operate during testing?

  Yes

  No

  N/A

• Heat Responsive Devices:

• Responsive devices used for special system(s)

  Select Heat Detectors Smoke Detectors Duct Detectors

  • Heat Detectors
  • Smoke Detectors
  • Duct Detectors

• e. Do any solenoid releasing valves operate as required?

  Yes

  No

  N/A

• List location of valves and valve models

8. ALARMS

• a. Did the water motors and gong operate during testing?

  Yes

  No

  N/A

• b. Did electric alarms operate during testing?

  Yes

  No

  N/A

• c. Did the supervisory alarms operate during testing?

  Yes

  No

  N/A

9. SPRINKLERS - PIPING

• a. Do sprinklers generally appear to be in good external condition?

  Yes

  No

  N/A

• b. Do sprinklers generally appear to be free of corrosion, paint, or loading and visible obstructions?

  Yes

  No

  N/A

• c. Are extra sprinklers and sprinkler wrench available on the premises?

  Yes

  No

  N/A

• Quantity, Size, Finish & Temperature of spare heads.

• d. Are any recalled sprinkler heads installed in visible areas of the building?

  Yes

  No

  N/A

• 10. THE INSPECTOR SUGGESTS THE FOLLOWING IMPROVEMENTS, HOWEVER, THESE SUGGESTIONS ARE NOT THE RESULT OF AN ENGINEERING SURVEY AND DO NOT REFLECT CONDITIONS ABOVE CEILINGS OR IN CONCEALED SPACES.

• 11. ADJUSTMENTS OR CORRECTIONS MADE.

• 12. LISTED CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT, AS ADVISED BY THE OWNER.

• 13. FURTHER EXPLANATIONS OF CERTAIN (NO OR YES) ANSWERS.

• INSPECTION AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE OWNER OR OWNERS REPRESENTATIVE.

• INSPECTOR SIGNATURE

  Sign

• DATE OF COMPLETED INSPECTION

  Date