Vindex Systems Fire Alarm Maintenance Certificate - VIN.Q.302

• Site Name:

• Conducted on

  Date

Customer overview

• Job Number:

• Site Name:

• Site Address:
  Address

System Overview

• I/We being the competent person(s) responsible (as indicated by my/our signatures below) for the servicing of the fire alarm system, particulars of which are set out below, I/We CERTIFY that the said work for which I/We have been responsible complies to the best of my/our knowledge and belief with the recommendations of Clause 45 of BS5839-1:2013 quarterly inspection of vented batteries/periodic inspection and test/inspection and test over a 12 month period (delete as applicable), except for the variations, if any, stated in this certificate.
  >. Relevant details of the work carried out and faults identified have been entered into the system log book.
  The extent of liability of the signatory is limited to the system described below. Extent of the system covered by this certificate

• Variations from the recommendations of Clause 45 of BS5839-1:2013 for periodic or annual inspection and test (as applicable).

• State the number of false alarms During the past 12 months:

• The above number of false alarms per 100 automatic fire detectors per annum (for category M systems enter "not applicable") are as follows:

• Maintenance Visits quarter number:

  Qtr 1

  Qtr 2

  Qtr 3

  Qtr 4

Functional Equipment Testing:

• FUNCTIONAL EQUIPMENT TESTING BELOW

• State Battery Voltage (prior to Load Test):

• State Battery Voltage (After Load Test completed):

• Control Panels please state Quantity and Type of Panel:

• Has the control equipment been tested

  Yes

• Have the alarm sounders been tested?

  Yes

  No - customer instruction

• Has the signal to the monitoring station been tested?

  Yes

  No

  N/A

• What type of signal has been received?

  Select Fire Fault Clear/Restore

  • Fire
  • Fault
  • Clear/Restore

• Condition Report Test

  A - Good Condition

  B - Below Standard

  C - Fail

  D - Critical, Life Safety

Supplementary Sheet Checklist EACH VISIT

• Examine the Log book, all okay? Comments raised?

• Have you completed the log book?

  Yes

• Are all ancillary functions of the panel OK?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Examine the batteries and their connections, load test with the mains disconnected OK?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do all manual call points remain unobstructed, conspicuous and undamaged?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are there any new exits without the provision of an adjacent manual call point? If so please list below

• Are there any new partitions within 500mm horizontally of any AFDC? If so please list below.

• Is there any storage encroaching within 300mm of ceiling such as to compromise compliance? If so lease list below

• Confirm that a clear space of 500mm is maintained below each AFD otherwise please state below which detectors need moving

• Have any changes to the use or occupancy of an area made the existing types of AFD unsuitable or prone to unwanted alarms? If so please describe below all changes affecting the fire alarm detection.

• Do any building alterations or extensions require additional detection / equipment? if so lease state below along with a sketch or media

• Sketch for any building modifications

  Drawing

• Please state below Details of Work completed/Comments & Additional work undertaken

• Any other issues conditions also with the installation additions or rectifications required also photos attach on media below

• Photos here of any issues or areas equipment required etc

  Media

Part Transactions:

• Have parts been used?

  Yes

  No

  N/A

• List materials used including quantities, part description, serial numbers:

• Are parts required?

  Yes

  No

  N/A

• List parts required including part numbers, voltages etc.

Engineers' Time Sheet a Summary:

• Enter Date & Time arrived on site:

  Date

• Enter Date & Time off site:

  Date

• Number of on-site hours:

• Number of travel hours:

Customer Acceptance:

• Engineers Name on behalf of Vindex:

• Vindex Engineer's Signature:

  Sign

• Customer Acknowledgement (INPUT NAME): I confirm the satisfactory completion of the above maintenance visit.

  Sign

• Customer Job Title:

• Customer Signature:

  Sign

Office use ONLY:

• Closed:

• Invoiced (where applicable):

• Actioned by:

• Date Closed:

Vindex Systems Company Details:

• Vindex Systems Limited, 7-8 Lloyds Court, Manor Royal, Crawley, West Sussex, RH10 9QU

• Document Reference Number Form51-2, Rev 1, June 2017