Harris County Fire Marshal's Office

• Business name

• Business Address

• OWNER /CONTRACTOR CONTACT:

• TELEPHONE NUMBER:

• EMAIL ADDRESS:

• DATE & TIME OF INSPECTION

  Date

• HCFMO Inspection Personnel

• Document No.

• Contracting firm / Service provider:

  Select Grove Construction 572-777-9599 Little Dixie 573-449-7200 Hercon 573-256-2865 Paric 636-561-9500 Trittenbach 573-449-9902 Holman Const 573-446-3360 Crawford 573-268-0867 McAfee 573-474-4397 Enrich 573-886-8494 OTHER Coil Construction 563-874-1444 Huebert Builders Inc. 573-449-4996

  • Grove Construction 572-777-9599
  • Little Dixie 573-449-7200
  • Hercon 573-256-2865
  • Paric 636-561-9500
  • Trittenbach 573-449-9902
  • Holman Const 573-446-3360
  • Crawford 573-268-0867
  • McAfee 573-474-4397
  • Enrich 573-886-8494
  • OTHER
  • Coil Construction 563-874-1444
  • Huebert Builders Inc. 573-449-4996

Contracting Firm/Service Provider

• Name of Service Provider

• Address

• Phone Number

• License Number

OCCUPANCY TYPE:

• OCCUPANCY USE?

  Select ASSEMBLY BUSINESS EDUCATIONAL FACTORY HIGH HAZARD INSTITUTIONAL MERCANTILE RESIDENTIAL STORAGE UNCLASSIFIED

  • ASSEMBLY
  • BUSINESS
  • EDUCATIONAL
  • FACTORY
  • HIGH HAZARD
  • INSTITUTIONAL
  • MERCANTILE
  • RESIDENTIAL
  • STORAGE
  • UNCLASSIFIED

• Do you need help with Assembly sub categories?

  Off

  On

• Assembly 1-5

  

• Which sub category is it?

  Select 1 2 3 4 5

  • 1
  • 2
  • 3
  • 4
  • 5

• Is the occupancy posted (if less than 50, it is not required)

  Yes

  No

  N/A

• How many people

• Do you need help with which occupancies are classified Business?

  Off

  On

• Business

  

• Do you need help with with which occupancies are classified as Educational?

  Off

  On

• Educational

  

• Do you need help with Factory sub categories?

  Off

  On

• F-1

  

• F-2

  

• Which sub category is it? F-1, F-2

  Select F-1 F-2

  • F-1
  • F-2

• Do you need help with High Hazard sub categories.

  Off

  On

• H-1

  

• H-2

  

• H-3

  

• H-4

  

• Which sub category is it? H-1, H-2, H-3, H-4

  Select H-1 H-2 H-3 H-4

  • H-1
  • H-2
  • H-3
  • H-4

• Do you need help with Institutional category?

  Off

  On

• I-1

  

• I-2

  

• I-3 Condition 1-4

  

• I-3 Condition 5

  

• I-4

  

• Which sub category is it?

  Select I-1 I-2 I-3 I-3 Condition 1 I-3 Condition 2 I-3 Condition 3 I-3 Condition 4 I-3 Condition 5 I-4

  • I-1
  • I-2
  • I-3
  • I-3 Condition 1
  • I-3 Condition 2
  • I-3 Condition 3
  • I-3 Condition 4
  • I-3 Condition 5
  • I-4

• Do you need help with which occupancies are Mercantile?

  Off

  On

• Mercantile

  

• Do you need help with Residential categories?

  Off

  On

• Residential 1-4

  

• Which Residential sub category is it?

  Select R1 R2 R3 R4

  • R1
  • R2
  • R3
  • R4

• Do you need help with Storage sub categories?

  Off

  On

• Storage 1 - 2

  

• Which Storage sub category is it?

  Select S-1 S-2

  • S-1
  • S-2

• Do you need help with which occupancies are Unclassified?

  Off

  On

• Group U

  

• WHAT TYPE OF SYSTEM/S INSPECTED?

  Select sprinkler piping sprinkler fire alarm fixed fire pump rolling fire door emergency generator fire final

  • sprinkler piping
  • sprinkler
  • fire alarm
  • fixed
  • fire pump
  • rolling fire door
  • emergency generator
  • fire final

Fire Final Inspection

Miscellaneous

• Address visible from road fronting the building, contrasting color, and a min. of 4" x .5" in size. Rear doors need suite numbers of the same minimum size (505.1)

  Yes

  No

  N/A

• Knox Box operational with current keys (506.1)

  Yes

  No

  N/A

• Fire lanes shall be marked (202)

  Yes

  No

  N/A

• Fire hydrants have a 3' cleared circumference (507.5.5)

  Yes

  No

  N/A

• Location of issue

  Media

• Other

Fire Protection Systems

• Fire extinguishers serviced annually (906)

  Yes

  No

  N/A

• Date of last annual inspection

  Date

• What is the Location?

Location

• Location

• Fire extinguishers minimum of 2A:10BC (906)

  Yes

  No

  N/A

• Location of issue

  Media

• Maximum travel to a fire extinguisher is 75' (906)

  Yes

  No

  N/A

• All doors to fire systems shall be label (914.2.4)

  Yes

  No

  N/A

• Other

Deficiency

Egress

• Minimum number of required exits (4>1000, 3 if 501 to 1000, 2 if 1 to 500, 1 exit is allowed if <50 people & <75' of travel) (Table 1021.1)

  Yes

  No

  N/A

• Egress path shall be clear of obstructions and clearly illuminated (1030)

  Yes

  No

  N/A

• Location of issue

  Media

• Exit signs shall be illuminated with battery backup (1011)

  Yes

  No

  N/A

• Location of issue

  Media

• Emergency egress lighting shall be operational with battery backup (1006)

  Yes

  No

  N/A

• Location of issue

  Media

• Egress doors will have a minimum of 32" clearance (1008.1.1)

  Yes

  No

  N/A

• Location of issue

  Media

• Minimum aisle clearance will be 36" (1017.2)

  Yes

  No

  N/A

• Location of issue

  Media

• Other

Electrical

• Electrical cords shall not pass through walls, ceilings or doorways (605.4.3)

  Yes

  No

  N/A

• Location of issue

  Media

• Electrical cords shall not be affixed to structures, and must be protected from damage (605)

  Yes

  No

  N/A

• Location of issue

  Media

• Extension cords shall not be used for permanent wiring (90 days), they will supply only one device and will be plugged into an approved receptacle, power tap, or multiplug adapter. The capacity of the extension cord shall be greater than the rated capacity of the PORTABLE appliance it supplies (605.5)

  Yes

  No

  N/A

• Location of issue

  Media

• Junction boxes, breaker panels, and electrical outlets shall have approved covers (605.1)

  Yes

  No

  N/A

• Location of issue

  Media

• Power strips shall be over current protected, UL listed, and plugged directly into wall outlets (605.4)

  Yes

  No

  N/A

• Location of issue

  Media

• Door into electrical control panel rooms shall be marked plainly and legibly "ELECTRICAL ROOM" (605.3.1)

  Yes

  No

  N/A

• Location of issue

  Media

• Electrical motors shall be free from excessive accumulations of oil, dirt, waste and debris (605.8)

  Yes

  No

  N/A

• Location of issue

  Media

• Other

Housekeeping

• Storage shall be maintained 24" below ceiling in nonsprinklered buildings, and 18" in sprinkler end buildings (315.3.1)

  Yes

  No

  N/A

• Location of issue

  Media

• Electrical panels, boilers and furnaces shall have a clearance from combustibles (NFPA) (315.2)

  Yes

  No

  N/A

• Location of issue

  Media

• Ceiling tiles shall be in place (703.1)

  Yes

  No

  N/A

• Location of issue

  Media

• Compressed gas cylinders shall be secured and protected from physical damage (5304)

  Yes

  No

  N/A

• Location of issue

  Media

• Gasoline stored on site?

  Yes

  No

  N/A

• Is it more than 10 gallons? (3404.3.4.4)

  Yes

  No

  N/A

• It must be in an approved cabinet and it can't be more than 60 gallons.

  Yes

  No

  N/A

EMERGENCY GENERATOR - NFPA 110 Section 7.13

• Is this a subcontractor?

  yes

  no

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

• With the prime mover in a "cold start" condition and the emergency load at standard operating level, a primary power failure shall be initiated by opening all switches or breakers supplying the primary power to the building or facility. The test load shall be that load that is served by the EPSS.

• What was the time delay on starting in seconds?

• What was the cranking time in seconds?

• What was the time required to reach operating speed in seconds?

• What was the voltage and frequency overshoot?

• What was the time required to reach a steady-state condition with all switches transferred to the emergency position?

• What were the voltage? Frequency? Amperes?

This next section is recorded at intervals!!!

• What were the prime mover oil pressure and water temperature, where applicable, and the battery charge rate (recorded at 5 min intervals for first 15 then at 15 min intervals until 2 hours have passed).

• 5 MINUTES Oil pressure Water temperature Battery charge rate

• 10 MINUTES Oil pressure Water temperature Battery charge rate

• 15 MINUTES Oil pressure Water temperature Battery charge rate

• 30 MINUTES Oil pressure Water temperature Battery charge rate

• 45 MINUTES Oil pressure Water temperature Battery charge rate

• 1 HOUR Oil pressure Water temperature Battery charge rate

• 1 hour 15 MINUTES Oil pressure Water temperature Battery charge rate

• 1 HOUR 30 MINUTES Oil pressure Water temperature Battery charge rate

• 1 HOUR 45 MINUTES Oil pressure Water temperature Battery charge rate

• 2 HOURS Oil pressure Water temperature Battery charge rate

• Was a load test with building load, or other loads that simulate the intended load continued for a minimum time for the class, or 2 hours maximum, observing and recording load changes and the resultant effect on voltage and frequency

  Yes

  No

  N/A

• Record the time delay when the primary power is returned to the building or facility, on retransfer to normal for each switch. (minimum setting 5 minutes). In minutes.

• Record the time delay on the prime mover cool down period and shutdown (in minutes).

After completion of above test, the prime mover shall be allowed to cool for 5 minutes.

• Was a 2 hour, full load test conducted? NFPA 110, 7.13.6

  Yes

  No

  N/A

• The building load can be permitted to serve as part of the load, supplemented by a load bank of sufficient size to provide a load equal to 100 percent of the nameplate kW rating of the EPS, less applicable debating factors for site conditions.

• Has the crank test been conducted per the manufacturers recommendations? NFPA 110, 7.13.9

  Yes

  No

  N/A

• Date system tested

  Date

• Did the generator pass?

  PASSED

  FAILED

  N/A

• Date system re-tested?

  Date

• Did the generator pass?

  PASSED

  FAILED

  N/A

• Date system re-tested?

  Date

• Did the generator pass?

  PASSED

  FAILED

  N/A

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

FIRE ALARM

• Is this a subcontractor?

  yes

  no

• Choose subcontractor

  enter information

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

• Alarm panel monitoring agency

  Tech Electronics = Center Point. 877-844-2202

  Midwest Electronics = Central dispatch 1-800-392-1310

  ACC

  other

• Name and phone number of monitoring agency?

• Alarm panel manufacturer and model #.

Notification appliances

• Horn Strobes

  yes

  no

• Number of Horn/Strobes?

• Voice Alarms

  yes

  no

• Number of voice alarms?

• Strobes

  yes

  no

• Number of strobes?

• Bells/Horns

  yes

  no

• Number of bell/horns?

Initiating devices

• Smoke Detectors?

  yes

  no

• Number of smoke detectors?

• Number of smoke detectors tested?

• Water flow switches?

  yes

  no

• Number of water flow switches?

• Number of water flow switches tested?

• Tamper switches?

  yes

  no

• Number of tamper switches?

• Number of tamper switches tested?

• Manual Pull Stations?

  yes

  no

• Number of manual stations?

• Number of manual stations tested?

• Projected beam smoke?

  yes

  no

• Number of projected beam smoke?

• Number of projected beam smoke tested?

• Heat detectors?

  yes

  no

• Number of heat detectors?

• Number of heat detectors tested?

• Fixed extinguishing system?

  yes

  no

• Fixed extinguishing system?

• Fixed extinguishing system tested?

• Other
What is it?

• Other?

• Other tested?

System test information

• Date of test

  Date

• Fire alarm system test results

  PASSED

  FAILED

  N/A

• Date of re-test

  Date

• Fire alarm system test results

  PASSED

  FAILED

  N/A

• Date of re-test

  Date

• Fire alarm system test results

  PASSED

  FAILED

  N/A

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

FIXED SUPPRESSION

• Is this a subcontractor?

  yes

  no

• Choose subcontractor

  enter information

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

System

• Location?

• Model information

• System type?

  WET CHEMICAL

  DRY CHEMICAL

  CLEAN AGENT

  APPROVED HALON

  FOAM

• Application?

  Commercial Cooking

  Computer Room

  Flammable Liquid Storage

  Flammable Spray Area

  Other

• Abort functioned appropriately?

  Yes

  No

  N/A

• Dump test completed?

  Yes

  No

  N/A

• Pre-alert functioned?

  Yes

  No

  N/A

• Automatic Shutdown Functioned Properly?

  Yes

  No

  N/A

• Exhaust system functioned properly?

  Yes

  No

  N/A

• Make-up air system functioned properly?

  Yes

  No

  N/A

• Pull station functioned properly?

  Yes

  No

  N/A

• System activated properly with test link?

  Yes

  No

  N/A

• System piping free of obstructions?

  Yes

  No

  N/A

• Take picture if desired?

  Media

• Horn/Strobe present?

  Yes

  No

  N/A

• Building fire alarm interface functioned?

  Yes

  No

  N/A

• Proper portable fire extinguisher (between 10-30 feet from cooking area?

  Yes

  No

  N/A

• Date of test

  Date

• Fixed Suppression system test results

  PASSED

  FAILED

  N/A

• Date of re-test

  Date

• Fixed Suppression system test results

  PASSED

  FAILED

  N/A

• Date of re-test

  Date

• Fixed Suppression system test results

  PASSED

  FAILED

  N/A

• Any Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

ROLLING FIRE DOOR

• Is this a subcontractor?

  yes

  no

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

Door

• Location of door?

• Door size?

• Serial number

• UL Tag number?

• Drops between 6-24 inches per second, with full closure?

  PASSED

  FAILED

  N/A

• Rolling door stops if obstruction (without causing bodily damage)

  Yes

  No

  N/A

• Date of test

  Date

• Did the Fire door pass?

  PASSED

  FAILED

  N/A

• Date of reinspection?

  Date

• Did the Fire door pass?

  PASSED

  FAILED

  N/A

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

FIRE PUMP TESTING - 2006 IFC and NFPA 20

• Is this a subcontractor?

  yes

  no

Contract provider information

• Name of contract provider

• Address

• Email address

• Phone number

General

• Received Fire pump system installation and test certificate from installer?

  PASSED

  FAILED

  N/A

• Received fire pump manufacturer pump curve certification test form?

  PASSED

  FAILED

  N/A

• Pressure and flush test certification is provided before performing the field acceptance test, 14.1.3.

  Yes

  No

  N/A

• The approved plan is on site?

  Yes

  No

  N/A

• Fire pump and controller, piping, gauges, jockey pump, and other component locations and design are the same as shown on the approved set of plans.

  Yes

  No

  N/A

• Fire pump has a name plate

  Yes

  No

  N/A

• A pressure gauge not less than 3 1/2" in diameter is near the pump discharge casting, and the pressure range is at least twice the rated working pressure of the pump but not less than 200 PSI, 5.10.1

  Yes

  No

  N/A

• A compound pressure/vacuum gauge not less than 3 1/2" in diameter is connected to the suction pipe and the pressure range is at least twice the rated maximum suction pressure of the pump but not less than 100 PSI, 5.10.2. This does not apply to vertical shaft-turbine pumps taking a water supply from an open pit or well.

  Yes

  No

  N/A

• When provided all valves ( suction, discharge, bypass, back flow or assembly isolation valves) shall be supervised open by an off-site monitoring company, a local signal, locked open, or by seals, 5.16.

  Yes

  No

  N/A

• Pump room has lighting, emergency lighting, heat, ventilation, and a floor drain, 5.12.2

  Yes

  No

  N/A

• A circulation relief valve is provided on the pump of at least, 3/4" for less than 2500 GPM and 1" for 3,000 to 5,000 GPM, and it discharges to a drain, 5.11.1. It's dies not apply to pumps providing cooling water from its discharge to the engine driver. DRAIN OUTSIDE

  Yes

  No

  N/A

• Coupling guards are provided for driver to pump connecting flexible couplings or flexible connecting shafts, 5.12.7.

  Yes

  No

  N/A

• Wen installed, the eccentric taper reducer for suction has the taper on the bottom, 5.14.6.4.

  Yes

  No

  N/A

• A check valve is installed in the pump discharge assembly, 5.15.6.

  Yes

  No

  N/A

• An indicating gate or butterfly valve is installed on the fire protection system side of the check valve, 5.15.7.

  Yes

  No

  N/A

• The test headed and the number of hose valves are provided, in accordance with Table 5.25 and their location matches the approved set of plans, 5.19.3.

  Yes

  No

  N/A

• The construction of the fire pump room (1 or 2 hour fire-resistive) matches the approved set of plans, 5.12.1, 5.12.2.

  Yes

  No

  N/A

• The pressure maintenance (jockey) pump has a check valve in its discharge piping and isolation valves (indicating butterfly or gate) location match the approved set of plans

  Yes

  No

  N/A

Operational tests are performed by the Contractor or Manufacturer.

• Flow tests for positive displacement pumps are performed and recorded in accordance with Sections 14.2.7.3.3 and A.14.2.7.3, using a flow meter in a test loop that discharges the flow back to supply.

  Yes

  No

  N/A

• For the load start test, the fire pump, without interruption, will be brought to rated speed providing a discharge equal to peak load, 14.2.7.4.

  Yes

  No

  N/A

Controller

• The fire pump controller is tested in accordance with the manufacturer's requirements and Section 14.2.8.

  Yes

  No

  N/A

• A minimum of 6 manual starts and 6 automatic starts are performed, split the tests between each set of engine batteries and emergency power ( only if emergency power is required for operating the pump) and simulate a loss of the primary power source to verify the transfer to secondary power source, 14.2.8.2 and 14.2.9.

  Yes

  No

  N/A

• Each start is no less than a 5 minute run time, and a total pump operation shall not be less than 1 hour, 14.2.8.4 and 14.2.12.

  Yes

  No

  N/A

• Simulate primary power loss and allow automatic transfer to secondary power supply (only I'd emergency power is required for operating the pump) while pump is operating at peak load, 14.2.9.1.

  Yes

  No

  N/A

• Packing pump drips

  Yes

  No

  N/A

• No overheating

  Yes

  No

  N/A

• No excessive vibration

  Yes

  No

  N/A

• Pump starts on water flow

  Yes

  No

  N/A

• Pump starts on pressure drop

  Yes

  No

  N/A

• Casing relief valve operates

  Yes

  No

  N/A

• Pressure relief valve operates

  Yes

  No

  N/A

• Jockey point stop pressure is recorded

  Yes

  No

  N/A

• Enter stop pressure

• Jockey pump start point pressure is recorded

  Yes

  No

  N/A

• Enter start pressure

• Fire point start point pressure is recorded (usually 5 PSI above jockey stop PSI)

  Yes

  No

  N/A

• Fire pump start pressure

• Pump flow test are conducted at churn (no flow), rated (100 percent of rated capacity), and peak (150 percent of rated capacity) loads, 14.2.7.2.1. Additional test points can be taken.

  Yes

  No

  N/A

Electric driven pump

• Supervised alarms operate when motor stops running, loss of phas, electric phase reversal and controller trouble.

  Yes

  No

  N/A

• Simulated test for phase reversal is conducted

  Yes

  No

  N/A

• Switching from normal power to emergency an dbsck to normal at peak load does not trip the breaker.

  Yes

  No

  N/A

• Pump started once from manual emergency handle operation

  Yes

  No

  N/A

• Pump start up on emergency power occurs automatically

  Yes

  No

  N/A

• Date of test

  Date

• Fire pump Testing Status ?

  PASSED

  FAILED

  N/A

• Date re-test started

  Date

• Fire pump Testing Status?

  PASSED

  FAILED

  N/A

• date re-test started

  Date

• Fire pump Testing Status?

  PASSED

  FAILED

  N/A

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

SPRINKLER PIPING

• Is this a subcontractor?

  yes

  no

• Choose subcontractor

  enter information

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

• Are you checking the entire system?

  Yes

  No

  N/A

• What part are you testing?

Area

• Enter area tested

• Do you need references?

  Off

  On

• Which reference would you like

  Select Hanger types head positioning general info

  • Hanger types
  • head positioning
  • general info

• Hanger types

  

• Head positioning

  

• General Information

  

• Date of test

  Date

• SPRINKLER PIPING - POSITION - SPACING - OBSTRUCTIONS?

  PASSED

  FAILED

  N/A

• What is wrong?

• Take picture if desired.

  Media

• Date of reinspection?

  Date

• SPRINKLER PIPING - POSITION - SPACING - OBSTRUCTIONS?

  PASSED

  FAILED

  N/A

• Is this the last section you need to check? Check if yes.

• RISER VALVES OR FDC FREE OF OBSTRUCTIONS?

  Yes

  No

  N/A

• Take picture if desired.

  Media

• Date removed?

  Date

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

• Date of test

  Date

• Do you need references?

  Off

  On

• Which reference would you like

  Select Hanger types head positioning general info

  • Hanger types
  • head positioning
  • general info

• Hanger types

  

• Head positioning

  

• General Information

  

• SPRINKLER PIPING - POSITION - SPACING - OBSTRUCTIONS?

  PASSED

  FAILED

  N/A

• What is wrong?

• Take picture if desired.

  Media

• Date of reinspection?

  Date

• SPRINKLER PIPING - POSITION - SPACING - OBSTRUCTIONS?

  PASSED

  FAILED

  N/A

• RISER VALVES OR FDC FREE OF OBSTRUCTIONS?

  Yes

  No

  N/A

• Date removed?

  Date

• Is FDC cap locked?

  Yes

  No

  N/A

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

SPRINKLER SYSTEM TESTING

• Is this a subcontractor?

  yes

  no

• Is this the same contractor as the sprinkler piping?

  Yes

  No

  N/A

• See piping contractor information.

• Choose subcontractor

  enter information

Contract provider information

• Name of contract provider

• Address

• Phone number

• Email address

General Data

• NUMBER OF SYSTEM RISERS?

  1

  2

  3

  4

  5

• AREA OF PROTECTION?

  TOTAL COVERAGE

  LIMITED AREA

Hydraulic Nameplate data

• Is hydraulic design information posted?

  Yes

  No

  N/A

• Entered date posted

  Date

• Door to sprinkler room properly labeled?

  Yes

  No

  N/A

• FDC service areas properly labeled?

  Yes

  No

  N/A

• Extra sprinkler heads and wrench in box?

  Yes

  No

  N/A

Testing

• Are you testing the entire sprinkler at this time?

  Yes

  No

  N/A

• What area is being tested?

Area

Hydrostatic Pressure Testing

• Hydrostatic Pressure Testing - Type of system?

  Select Wet Dry

  • Wet
  • Dry

Wet system 200 psi (<=2psi in 2 hours)

• Time and date hydro test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Time and date hydro re-test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Time and date re-test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Comments?

Alarm trip status wet

• Date of alarm trip test

  Date

• Time to trip (less than 60 seconds)?

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Date of alarm trip status re-test?

  Date

• Time to trip (less than 60 seconds)?

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Date of alarm trip status re-test?

  Date

• Time to trip

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Comments?

Dry system 40 psi (0 psi loss in 24 hours)

• Date and time DRY hydro test started?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Is this an NFPA 13 exemption (less than 500 gal system)?

  Yes

  No

  N/A

• Time and date of DRY hydro re-test?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Time to deliver water (less than 60 seconds)?

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Time and date of Dry hydro re-test?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Comments?

Flow test dry

• Date of flow test?

  Date

• Time to deliver water (less than 60 seconds)?

• FLOW TEST STATUS?

  PASSED

  FAILED

  N/A

• Date of flow re-test?

  Date

• Time to deliver water (less than 60 seconds)?

• FLOW TEST STATUS?

  PASSED

  FAILED

  N/A

• Comments?

Main drain test

• Are you ready to perform main drain test?

• Date of test

  Date

• Is it piped to exterior?

  Yes

  No

  N/A

• Static reading?

• Residual reading? (cannot drop below 20 Psi)

• Results?

  PASSED

  FAILED

  N/A

• Date of Main Drain re-test?

  Date

• Static reading?

• Residual reading? (cannot drop below 20 Psi)

• Results?

  PASSED

  FAILED

  N/A

• Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

• Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

Fire Alarm test

• Are you read to conduct Fire Alarm testing?

• Alarm panel monitoring agency

  Tech Electronics = Center Point. 877-844-2202

  Midwest Electronics = Central dispatch 1-800-392-1310

  ACC

  other

• Name and phone number of monitoring agency?

• Water flow/tamper activated alarm panel?

  Yes

  No

  N/A

• Horn/strobe above FDC?

  Yes

  No

  N/A

• UListed Alarm Panel?

  Yes

  No

  N/A

• Control valves properly labeled?

  Yes

  No

  N/A

• Control valves properly secured with tamper switches?

  Yes

  No

  N/A

• Fire Hydrant within 100' of FDC?

  Yes

  No

  N/A

• ALL SYSTEMS RETURNED TO SERVICE?

  Yes

  No

  N/A

Hydrostatic Pressure Testing

• Hydrostatic Pressure Testing - Type of system?

  Select Wet Dry

  • Wet
  • Dry

Wet system 200 psi (<=2psi in 2 hours)

• Time and date hydro test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Time and date hydro re-test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Time and date re-test started

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status WET?

  PASSED

  FAILED

  N/A

• Comments?

Alarm trip status wet

• Date of alarm trip test

  Date

• Time to trip (less than 60 seconds)?

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Date of alarm trip status re-test?

  Date

• Time to trip (less than 60 seconds)?

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Date of alarm trip status re-test?

  Date

• Time to trip

• ALARM TRIP STATUS?

  PASSED

  FAILED

  N/A

• Comments?

Dry system 40 psi (0 psi loss in 24 hours)

• Date and time DRY hydro test started?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Is this an NFPA 13 exemption (less than 500 gal system)?

  Yes

  No

  N/A

• Time and date of DRY hydro re-test?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Time to deliver water (less than 60 seconds)?

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Time and date of Dry hydro re-test?

  Date

• Starting pressure

• Time and date test ended

  Date

• Ending pressure

• Hydrostatic Pressure Testing Status DRY?

  PASSED

  FAILED

  N/A

• Comments?

Flow test dry

• Date of flow test?

  Date

• Time to deliver water (less than 60 seconds)?

• FLOW TEST STATUS?

  PASSED

  FAILED

  N/A

• Date of flow re-test?

  Date

• Time to deliver water (less than 60 seconds)?

• FLOW TEST STATUS?

  PASSED

  FAILED

  N/A

• Comments?

Main drain test

• Date of test

  Date

• Is it piped to exterior?

  Yes

  No

  N/A

• Static reading?

• Residual reading? (cannot drop below 20 Psi)

• Results?

  PASSED

  FAILED

  N/A

• Date of Main Drain re-test?

  Date

• Static reading?

• Residual reading? (cannot drop below 20 Psi)

• Results?

  PASSED

  FAILED

  N/A

• Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

• Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

Fire Alarm test

• Alarm panel monitoring agency

  Tech Electronics = Center Point. 877-844-2202

  Midwest Electronics = Central dispatch 1-800-392-1310

  ACC

  other

• Name and phone number of monitoring agency?

• Water flow/tamper activated alarm panel?

  Yes

  No

  N/A

• Horn/strobe above FDC?

  Yes

  No

  N/A

• UListed Alarm Panel?

  Yes

  No

  N/A

• Control valves properly labeled?

  Yes

  No

  N/A

• Control valves properly secured with tamper switches?

  Yes

  No

  N/A

• Fire Hydrant within 100' of FDC?

  Yes

  No

  N/A

• ALL SYSTEMS RETURNED TO SERVICE?

  Yes

  No

  N/A

• Comments?

• Customer's signature

  Sign

• Fire Marshal's signature

  Sign

• FINAL SYSTEM TESTING RESULTS

  PASSED

  FAILED

  N/A

DEFICIENCY ISSUES & REINSPECTION ITEMS:

REINSPECTION INFORMATION:

• REINSPECTION NEEDED?

  yes

  no

• REINSPECTION DATE & TIME

  Date

• FINAL SYSTEM RE-TESTING RESULTS

  PASSED

  FAILED

  N/A

• Follow up notes

• Follow up notes

• Follow up notes

• Building representative

  Sign

• Fire Marshal's

  Sign

• Building representative

  Sign

• Fire Marshal's

  Sign