Pre-Action/Deluge - Fire Sprinkler Inspection Report

• Document No.

• Company's Name

• Company's Address (Street/Suite#/City/State/Zip)

• Conducted on

  Date

• Prepared by

• Personnel

Information

• GFS Texas Order Number:

• Date and Time

  Date

• Report To:

• Site Inspection's Address (Street/Suite/City/State/Zip)

• Is the building occupied?

  Yes

  No

  N/A

• Has the Building Owner been notified?

  Yes

  No

• Has the Fire Marshall been Notified? (If "No" does the FM need to notified to perform inspection)

  Yes

  No

• Has the building's Security/Maintenance been notified of fire suppression system testing?

  Yes

  No

General Section (A) - To only be answered by the Owner or Owner's Representative

• Is the Owner or Owner's Representative Present during inspection?

  Yes

  No

• Name, Title and Signature

  Sign

• Have there been any changes in the occupancy classification or operation since last inspection?

  Yes

  No

  N/A

• Have there been any changes or repairs to the fire protection system since last inspection?

  Yes

  No

  N/A

• Has a fire occurred since last inspection?

  Yes

  No

  N/A

• Have damaged sprinkler components been replaced?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the buildings areas protected by a wet system, heated, including the blind attic and perimeter areas, where accessible?

  Yes

  No

  N/A

• Have there been any irregularities in pump operation during weekly/monthly test? (If applicable)

  Yes

  No

  N/A

• Are any of the sprinkler heads 50 years old or older?

  Yes

  No

  N/A

General Section (B)- to only be answered by Inspector

• Does there appear to be proper clearance between the top of all storage and the sprinklers' deflectors?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all visible exterior opening protected against the entrance of cold air?

  Yes

  No

  N/A

• Have all fire pumps been tested to their full capacity through the use of hose streams or flow meter within the past 12 months?

  Yes

  No

  N/A

• What type of inspection has the Owner been performing on the fire suppression systems?

  Select Weekly Monthly Quaterly Semi-Annual Annual Third Year Fifth Year Special None

  • Weekly
  • Monthly
  • Quaterly
  • Semi-Annual
  • Annual
  • Third Year
  • Fifth Year
  • Special
  • None

• Are these inspection performed at normal intervals?

  Yes

  No

  N/A

General Inspection Questions

City Connection

• City Connection

Connection

• What type of water supply

  City

  Gravity Tank

  Other

• Other Type

Test Pipe

• What is the test pipe connection?

• What is the size of the test pipe? (inches)

• Static pressure before (psi)

• Flow Pressure (psi)

• Static pressure after (psi)

Backflow

• Title of Backflow

• What type are the valves?

• Are valves "Easily Accessible"?

  Yes

  No

  N/A

• Are signs visible and legible?

  Yes

  No

  N/A

• Are the valves open?

  Yes

  No

  N/A

• Are the valves secured?

  Yes

  No

  N/A

• Is the tamper operational?

  Yes

  No

  N/A

• Photo of Backflow

  Media

Select Type of Inspection

• Any "No" answer, test failures or other problems found with the sprinkler system must be explained in each comment section provide with the question

• Weekly Inspection

Weekly

• Are the control valves supervised with seals in correct (open or closed) position

  Yes

  No

  N/A

• Are Backflow preventers valves in correct (open or closed) position?

  Yes

  No

  N/A

• Are Backflow preventers sealed, locked or supervised and accessible

  Yes

  No

  N/A

• If sprinklers have been replaced, were proper replacement used?

  Yes

  No

  N/A

• Monthly Inspection (in addition to previous inspection section)

Monthly

• Are control valves with locks or electrical supervision in correct (open or closed) position?

  Yes

  No

  N/A

• Sprinkler wrench with spare sprinklers?

  Yes

  No

  N/A

• Gauges in good condition?

  Yes

  No

  N/A

• Are alarm valves: gauges show normal supply water pressure, free from physical damage, valves in correct (open or closed) position and no leakage from retarding chamber or drains?

  Yes

  No

  N/A

• Quarterly Inspection (in addition to previous inspection section)

Quarterly

• Pressure reducing valves: in open position, not leaking, maintaining downstream pressure per design criteria and in good condition with handwheels not broken?

  Yes

  No

  N/A

• Are the hydraulic nameplates securely attached to risers and legible?

  Yes

  No

  N/A

• Fire Department connections: Visible, accessible, couplings and swivels not damaged and rotate smoothly, plugs or caps in place and undamaged, gaskets in place and in good condition, identification sign(s) in place, check valve is not leaking, clapper is in place and operating properly and automatic drain valve in place and operating properly?

  Yes

  No

  N/A

• If plugs or caps are not in place on the Fire Department Connection, inspect interior for obstructions.

• Alarm devices free from physical damage?

  Yes

  No

  N/A

Testing

• Mechanical waterflow alarm devices passed test by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

  Yes

  No

  N/A

• Did post indicting valves open until spring or torsion is felt in the rod? (then closed back one quarter turn)

  Yes

  No

  N/A

• Semi-Annual Inspection (in addition to previous inspection section)

Semi-Annual

• Valve supervisory switches indicate movement?

  Yes

  No

  N/A

• Electrical waterflow alarm devices passed tests by opening the inspector's test connection or bypass connection with alarms actuating and flow observed?

  Yes

  No

  N/A

• Annual Inspection (in addition to previous inspection section)

Annual

• Proper number and type of spare sprinklers?

  Yes

  No

  N/A

Visible sprinklers:

• Free of corrosion and physical damage?

  Yes

  No

  N/A

• Free of obstructions to spray patterns?

  Yes

  No

  N/A

• Free of foreign materials including paint?

  Yes

  No

  N/A

• Liquid in all glass bulb sprinklers?

  Yes

  No

  N/A

Visible pipe:

• In good condition/no external corrosion?

  Yes

  No

  N/A

• No mechanical damage and no leaks?

  Yes

  No

  N/A

• Properly aligned and no external loads?

  Yes

  No

  N/A

• Are visible pipe hangers and seismic braces damaged or loose?

  Yes

  No

  N/A

• Does VISIBLE wet pipe have adequate heat?

  Yes

  No

  N/A

• Has an internal inspection of the pipe been performed by removing the flushing connection and one sprinkler near the end of the branchline within the last five (5) years? (If not, conduct an internal inspection) Take Pictures

  Yes

  No

Testing

• Are all sprinkler dated 1920 or later?

  Yes

  No

  N/A

• Fast response sprinkler 20 or more years old replaced or successfully sample tested within last 10 years?

  Yes

  No

  N/A

• Standard response sprinkler 50 or more years old replaced or successfully sample tested within last 10 years?

  Yes

  No

  N/A

• Standard response sprinkler 70 or more years old replaced or successfully sample tested within last 5 years?

  Yes

  No

  N/A

• Dry-type sprinklers replaced or successfully sample tested within last 10 years?

  Yes

  No

  N/A

• All control valves operated through full range and returned to normal position?

  Yes

  No

  N/A

• Backflow devices pass backflow test?

  Yes

  No

  N/A

• Backflow devices pass full flow test?

  Yes

  No

  N/A

• Pressure reducing valves passed partial flow test?

  Yes

  No

  N/A

• Fifth year inspection (in addition to previous inspection section)

Fifth year

• Check valves internally inspected and all parts operate properly move freely and are in good condition?

  Yes

  No

  N/A

Testing

• Sprinkler rated above High temperature tested?

  Yes

  No

  N/A

• Gauges checked by calibrated gauge or replaced?

  Yes

  No

  N/A

• Pressure reducing valves passed full flow test?

  Yes

  No

  N/A

• Additional Photos

  Media

• Additional Comments

Pre-Action Systems

• Note: Before any Dry pipe, Deluge, or Pre-action valve is trip tested. the water supply lines should be throughly flushed. The two-inch drain below the valve should be opened wide and water at full pressure should be discharged long enough to clear pipe of any accumulation of scale or foreign material. the drip valve on the dry pipe valve should be checked before tripping the dry pipe valve to see that it is in operating condition.

• Total Number of Pre-Action Systems?

• Pre-Action System

Pre-Action

• Title of Pre-Action System

• What area is the Pre-action system protecting?

• Approximate number of sprinkler heads on system?

• Pre-Action Valve Photos

  Media

• Pre-Action Valve Information (Make/Model/Year)

• Pre-Action Valve Size (inches)

• Is the Pre-action valve "Easily Accessible"?

  Yes

  No

  N/A

• Are signs visible and legible?

  Yes

  No

  N/A

• Is the valve open? (if no, is it supposed to be closed?)

  Yes

  No

  N/A

• Is the valve secured?

  Yes

  No

  N/A

• Is the tamper operational?

  Yes

  No

  N/A

• What color tag was placed on the riser after inspection? (If a Yellow or Red tag is select) What is the deficiency?

  Blue

  Yellow

  Red

Alarms

• Did the water motor gong operate during testing?

  Yes

  No

  N/A

• Did the electrical alarms operate during testing?

  Yes

  No

  N/A

• Did the supervisory alarms operate during testing?

  Yes

  No

  N/A

• Was the water flow alarm indicator and retard test satisfactory?

  Yes

  No

  N/A

• What was the time? (seconds)

General Pre-Action Inspection

• Any "No" answer, test failures or other problems found with the sprinkler system must be explained in each comment section provide with the question

• Gauges in good condition and showing normal air and water pressure?

  Yes

  No

  N/A

• Valve enclosure maintaining at least 40F?

  Yes

  No

  N/A

• For freezer systems, is the gauge near the compressor reading the same as the gauge near the pre-action valve?

  Yes

  No

  N/A

• Valves free from physical damage, trim valve in appropriate (open or closed) position, no leak from valve seat, and all electrical components in sevice?

  Yes

  No

  N/A

• Is the priming level correct and has the low air pressure signal passed it's test?

  Yes

  No

  N/A

• Pre-Action valve that need to be opened to be reset passed internal inspections?

  Yes

  No

  N/A

• Low temperature alarms passed test?

  Yes

  No

  N/A

• Pipe through freezers free of ice blockage?

  Yes

  No

  N/A

• Has an internal inspection or the pipe been performed by removing the flushing connection and one sprinkler near the end of a branchline within the last five (5) years?(If the answer is "No," conduct an internal inspection)

  Yes

  No

  N/A

• Automatic air maintenance devices on preaction systems passed test?

  Yes

  No

  N/A

• Strainers, filters, restricted orifices and diaphragm chambers passed internal inspection?

  Yes

  No

  N/A

• Pre-action valve that can externally reset passed internal inspection?

  Yes

  No

  N/A

• Have low point drains been emptied?

  Yes

  No

  N/A

• If any of the following were discovered, was an obstruction investigation conducted?

  Yes

  No

• If the conditions were found that required flushing, was flushing of system conducted?

  Yes

  No

  N/A

• 1. Defective intake screen on pump with suction from open source
  2. Obstructive material discharged during waterflow tests
  3. Foreign materials found in dry-pipe valves, check valves or pumps
  4. Foreign material in water during drain test or plugging of inspector's test connection
  5. Plugging of pipe of sprinklers found during activation or alteration
  6. Failure to flush yard piping or surrounding public mains following new installation
  7. Record of broken mains in the vicinity
  8. Abnormally frequent false-tripping of dry-pipe valve
  9. System is returned to service after extended period out of service (greater than 1 year)
  10. There is reason to believe the system contains sodium silicate or its derivatives or highly corrosive fluxes in copper pipe systems

Testing

Main Drain Test:

• Record Static Pressure (psi)

• Recored Residual Pressure (psi)

• Was flow observed?

  Yes

  No

  N/A

• Are the results comparable to previous?

  Yes

  No

  N/A

Full Flow Trip Test: (not required where water can't be discharged. Test all systems together that will operate simultaneously.)

• Discharge from all nozzles unimpeded?

  Yes

  No

  N/A

• Pressure reading at hydraulically most remote nozzle? (psi)

• Residual pressure reading at valve? (psi)

• Above readings comparable to design valves?

  Yes

  No

  N/A

• Manual activation devices passed test?

  Yes

  No

  N/A

• Additional Notes

• Additional Photos

  Media

Deluge Systems

• Total Number of Deluge Systems?

• Deluge System

Deluge

• Title of Deluge System

• What area is the Deluge system protecting?

• Approximate number of sprinkler heads on system?

• Deluge Valve Photos

  Media

• Deluge Valve Information (Make/Model/Year)

• Deluge Valve Size (inches)

• Is the Deluge valve "Easily Accessible"?

  Yes

  No

  N/A

• Are signs visible and legible?

  Yes

  No

  N/A

• Is the valve open? (if no, is it supposed to be closed?)

  Yes

  No

  N/A

• Is the valve secured?

  Yes

  No

  N/A

• Is the tamper operational?

  Yes

  No

  N/A

• What color tag was placed on the riser after inspection? (If a Yellow or Red tag is select) What is the deficiency?

  Blue

  Yellow

  Red

Alarms

• Did the water motor gong operate during testing?

  Yes

  No

  N/A

• Did the electrical alarms operate during testing?

  Yes

  No

  N/A

• Did the supervisory alarms operate during testing?

  Yes

  No

  N/A

• Was the water flow alarm indicator and retard test satisfactory?

  Yes

  No

  N/A

• What was the time (seconds)

General Deluge Inspection

• Any "No" answer, test failures or other problems found with the sprinkler system must be explained in each comment section provide with the question

• Gauges in good condition and showing normal air and water pressure?

  Yes

  No

  N/A

• Valve enclosure maintaining at least 40F?

  Yes

  No

  N/A

• For freezer systems, is the gauge near the compressor reading the same as the gauge near the pre-action valve?

  Yes

  No

  N/A

• Valves free from physical damage, trim valve in appropriate (open or closed) position, no leak from valve seat, and all electrical components in sevice?

  Yes

  No

  N/A

• Is the priming level correct and has the low air pressure signal passed it's test?

  Yes

  No

  N/A

• Deluge valve that need to be opened to be reset passed internal inspections?

  Yes

  No

  N/A

• Low temperature alarms passed test?

  Yes

  No

  N/A

• Pipe through freezers free of ice blockage?

  Yes

  No

  N/A

• Has an internal inspection or the pipe been performed by removing the flushing connection and one sprinkler near the end of a branchline within the last five (5) years?(If the answer is "No," conduct an internal inspection)

  Yes

  No

  N/A

• Automatic air maintenance devices on dry-pipe and preaction systems passed test?

  Yes

  No

  N/A

• Strainers, filters, restricted orifices and diaphragm chambers passed internal inspection?

  Yes

  No

  N/A

• Deluge valve that can externally reset passed internal inspection?

  Yes

  No

  N/A

• Have low point drains been emptied?

  Yes

  No

  N/A

• If any of the following were discovered, was an obstruction investigation conducted?

  Yes

  No

• If the conditions were found that required flushing, was flushing of system conducted?

  Yes

  No

  N/A

• 1. Defective intake screen on pump with suction from open source
  2. Obstructive material discharged during waterflow tests
  3. Foreign materials found in dry-pipe valves, check valves or pumps
  4. Foreign material in water during drain test or plugging of inspector's test connection
  5. Plugging of pipe of sprinklers found during activation or alteration
  6. Failure to flush yard piping or surrounding public mains following new installation
  7. Record of broken mains in the vicinity
  8. Abnormally frequent false-tripping of dry-pipe valve
  9. System is returned to service after extended period out of service (greater than 1 year)
  10. There is reason to believe the system contains sodium silicate or its derivatives or highly corrosive fluxes in copper pipe systems

Testing

Main Drain Test:

• Record Static Pressure (psi)

• Recored Residual Pressure (psi)

• Was flow observed?

  Yes

  No

  N/A

• Are the results comparable to previous?

  Yes

  No

  N/A

Full Flow Trip Test: (not required where water can't be discharged. Test all systems together that will operate simultaneously.)

• Discharge from all nozzles unimpeded?

  Yes

  No

  N/A

• Pressure reading at hydraulically most remote nozzle? (psi)

• Residual pressure reading at valve? (psi)

• Above readings comparable to design valves?

  Yes

  No

  N/A

• Manual activation devices passed test?

  Yes

  No

  N/A

• Additional Notes

• Additional Photos

  Media

Conclusion

• Although these comments are not the result of and engineering review, the following improvements are recommended for code compliance

• Deficiencies and Recommendations

• Additional Photos

  Media

• Additional Notes

• Inspector Signature

  Sign

• Do any the fire suppression inspected today need a "Fifth Year Obstruction Investigation"

  Yes

  No

• Did the owner decline the investigation?

  Yes

  No

• I the under signed have declined to have a fifth year obstruction investigation. I am completely aware and understand the risks associated with not having a fifth year obstruction investigation done. I do not hold GFS Texas responsible for anything that causes damage to personnel or property by an obstruction in the fire suppression system. (Type name and Title)

  Sign

• Disclaimer:
  
  The fire inspector believes the information contained within this "Fire Inspection" report to be correct at the time of printing. The fire inspector/GFS Texas does not accept responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the inspector during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made.
  
  Fire suppression systems that are not properly maintained and serviced can present a risk to life safety and property. This inspection is to assist in maintaining the fire suppression system and should not be relied upon as the sole basis for maintaining the system inspected.
  
  As Per NFPA 25 14.2.1 "An inspection of piping and branch line condition shall be conducted every five (5) years by opening a flushing connection at the end of one main and by removing a sprinkler toward the end of one main and by removing a sprinkler toward the end of one branch line for the purpose of inspecting for the presence of foreign organic and inorganic material." This investigation is to insure that the fire suppression systems do not show any evidences of an obstruction that could impair the system.
  
  GFS Texas is not responsible for any damage, to life (or/and) property due to neglect of properly heating area with wet pipe fire suppression system or dry pipe/pre-action fire suppression system that contain water due to tripped valves and system not being completely drain afterwards.
  
  Confindetiality Statement:
  
  In order to maintain the integrity and credibility of the fire inspection processes and to protect the parties involved, it is understood that the fire inspector will not divulge to unauthorized persons any information obtained during this inpseciton unless legally obligated to do so.
  

• Owner's or Owner's Representative Signature (I have read the above disclaimer and understand its content)

  Sign
Witness

• Name - Title and Signature

  Sign