TPE Smoke Alarm Yearly Test

• Document No.

• Customer Name:

• Site Address:

• Conducted on

  Date

General Inspection

• Does the property contain the correct number of smoke alarms? (At least one alarm on each level)

  Yes

  No

• Is the existing smoke alarm photoelectric? If no, then smoke alarm must be replaced.

  Yes

  No

• Are the smoke alarms installed in the correct locations?

  Yes

  No

• Are the smoke alarms securely fixed in place?

  Yes

  No

Smoke Alarms

• Please add for each Smoke Alarm

Smoke Alarm

• Smoke alarm location

  Select Ground Floor 2nd Floor Hallway Inside Outside Main Bedroom Bedroom 2 Bedroom 3 Bedroom 4 Kitchen Bathroom Office Garage Other

  • Ground Floor
  • 2nd Floor
  • Hallway
  • Inside
  • Outside
  • Main Bedroom
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Kitchen
  • Bathroom
  • Office
  • Garage
  • Other

• Smoke Alarm Expiry Date

• Hard wired or 10 year lithium battery?

  Hard Wired

  10 Year Lithium Battery

• Smoke alarm complies with AS3786-1993

  Yes

  No

• Smoke alarm cleaned and vacuumed?

  Yes

  No

• 9 Volt battery replaced?

  Yes

  No

  N/A

• Audible Test (Mains Power)

  Pass

  Fail

• Audible Test (Battery / Battery Backup)

  Pass

  Fail

• Visual Test (Mains Power)

  Pass

  Fail

• Visual Test (Battery / Battery Backup)

  Pass

  Fail

• Full function test using artificial smoke

  Pass

  Fail

• Did the smoke alarm pass testing?

  Yes

  No

• If Smoke Alarm replaced, replaced with?

  Select 240V + 9V Battery BackUp Photoelectric 10 year Lithium Battery Photoelectric Wireless Interconnect Base

  • 240V + 9V Battery BackUp Photoelectric
  • 10 year Lithium Battery Photoelectric
  • Wireless Interconnect Base

• TPE sticker applied over battery?

  Yes

  No

• Date written on smoke alarm?

  Yes

  No

• Insect surface spray applied to alarm surround?

  Yes

  No

Notes and recommendations

• undefined

Next test due date

• Select date

  Date

Compliance Statement

• This compliance certificate is to confirm the installation and operational compliance of the smoke detectors with AS3786:2014 at the above listed address and state that they have been hard wired to the electrical system &/or are 10-year lithium battery and interconnected in accordance with the Queensland Fire and Emergency Services legislation.

Completed By:

• Electrician:

  Tim Payne

  Bradley Antonello

  Cooper Léa

  Ryan Thornton

  Matt Galvin