Smoke Detector Test

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

Testing of Detectors

• Have all Smoke Detectors in the installation been tested?

  Yes

  No

  N/A

• How many Smoke Detectors were tested?

• Have all detectors that were tested passed the operational test procedures?

  Yes

  No

  N/A

• How many Smoke Detectors were tested?

• Have all Smoke Detectors that failed the tests been replaced?

  Yes

  No

  N/A

• Is any further action required to meet compliance of this installation?

  Yes

  No

  N/A

Next test due date

• Your next test is due on:

  Date

Confirmation

• Further to the installation of smoke detectors at the listed address above, this compliance certificate is to confirm the installation of smoke detectors and state their installation and operational compliance, and that they have been hard wired to the electrical system in accordance with the above standards.

• Full Name and Signature of Inspector or Authorized Representative

  Sign