• Contact Information:

Fire Sprinkler Systems

  • Is this facility sprinklered?

  • Enter inventory for the following:

  • Wet sprinkler risers

  • Dry sprinkler risers

  • Floor Control valve assembly (not counted in riser count)

  • Antifreeze loops

  • Pre action systems

  • Deluge systems

  • Hose valves (outlet count including those on standpipes)

  • Standpipe riser count

  • Fire department connections (FDC)

  • Other Fire Sprinkler Information:

  • Last Annual Test Date

  • Photo

  • Has the facility conducted 5 year inspections?

  • Date of Last 5 Year Inspection:

Fire Pumps

  • Is the facility provided with a fire pump?

  • How many fire pumps are present?

  • Type of fire pump(s)

  • Size of fire pump(s)

  • Are any of the fire pumps located not at grade and /or require special provisions to test?

  • Please describe testing arrangements required

  • Other Fire Pump Information:

  • Last Annual Test Date

  • Photo

Water Storage Tanks

  • Is a fire water storage tank present at this site?

  • Enter size and type of water storage tank

  • Last 5 Year Inspection

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Fire Alarm System

  • Is a fire alarm system installed in this facility?

  • Panel Make / Model

  • Enter inventory for the following:

  • Manual Pull Stations

  • Smoke detectors

  • Heat Detectors

  • Heat detectors

  • Beam detectors

  • Duct detectors

  • Water flow switches (include all including riser)

  • Tamper switches (include all including riser, floor control and pump tampers)

  • Pressure switches (ie dry riser flows)

  • Horn

  • Horn / Strobe

  • Strobe

  • Bell

  • Other (list and describe)

  • Are all of the above devices accessible from the floor level or with maximum 20 ft test pole?

  • Describe what is not accessible from floor or with test pole:

  • Can sensitivity testing of smoke detectors be done by the panel or must it be manually tested?

  • Other fire alarm system information:

  • Last Annual Inspection

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Portable Fire Extinguishers

  • Is client responsible for testing and inspection of portable extinguishers?

  • Enter number of portable extinguishers at facility:

  • Last Annual Inspection Date:

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Backflow Preventors

  • Is client responsible for testing and inspection of Backflow preventers?

  • Enter number of Backflow preventers at facility:

  • Last Annual Inspection Date:

  • Photo

Kitchen Hood Systems

  • Are kitchen hood suppression systems installed at this facility?

  • Is client responsible for testing and inspection of kitchen hood suppression systems?

  • Enter number of kitchen extinguishing systems (control heads) at facility:

  • Enter total number agent bottles:

  • Enter total number links (if known):

  • Last Semi-Annual Inspection Date:

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Emergency Lighting

  • Is client responsible for testing and inspection of emergency lighting?

  • Is the emergency lighting supplied by battery back up units or generator?

  • Enter number of battery lighting units at facility:

  • Are the lighting units in individual circuits (ie one or more dedicated breakers serve the emergency lighting) or mixed so each light is tested at the unit?

  • Enter number of generators at facility:

  • Last Annual Inspection Date:

  • Photo

Special Agent Suppression Systems

  • Is client responsible for testing and inspection of any clean / special agent systems?

  • Enter description of systems present:

  • Enter system configuration, number tanks, tank size etc.

  • Do any of these systems have a dedicated releasing panel?

  • Enter summary of devices on releasing panel:

  • Last Semi-Annual Inspection Date:

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Facility Summary

  • Enter description of facility and operations:

  • How many buildings are included at this location under this report? Include proximity if multiple buildings are covered in this report.

  • What are operating hours of facility?

  • When can inspections be conducted and are there any restrictions?

  • Are there any security restrictions or access control features that can delay inspections?

  • Is any special training required for inspectors before entering this site?

  • Describe training required:

  • Enter facility drawing if available.

  • Site Photo

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