TIME FOR WATER TO REACHINSPECTOR'S TEST VALVE:

MAKEVALVE INFO: SIZE DATE

CONTROL VALVES

SECONDS

MODEL SN #

PRESSURE REGULATING VALVES TESTED? (5YRS)

MODEL

ARE ALL CONTROL VALVES IN THE OPEN POSITION LOCKED / SEALED / TAMPERED?

YES NO

FLOW SWITCHES, SUPER-VISORY SWITCHES, AND ALARM BELL TESTED?

DID Q.O.D. OPERATE PROPERLY?

SYSTEM INSPECTED AND LUBRICATED?

ALARM REC'D AT CENTRAL STATION MONITORING?

CONDUCTED IN

ALARM BELL OPERATES?

COMMENTS:

N/ANO

SYSTEM CONFIDENCE TEST REPORT

ACCELERATOR (Q.O.D) PRESENT?

ANNUALSEMI-ANNUAL QUARTERLY

ADDRESS

NAME OF FACILITY

DATE INSPECTED:

STATIC PRESS: PSI

VALVE INFO: MAKE

NO N/A

N/ACENTRAL STATION MONITORING?

NO N/ADID WATER MOTOR GONG TEST SATISFACTORILY?

ARE ALL SPRINKLER SYSTEM CONTROL VALVES AND ALL OTHER VALVES IN THE APPROPRIATE OPEN OR CLOSED POSITION?

YES

WATER FLOW ALARM?

NO N/A

PSI

SYSTEM LOW POINTS DRAINED & RESTORED?

INTERNAL EXAM OF PIPING WERE THE HEAT ACTUATION DEVICES TESTED ON PRE- ACTION & DELUGE SYTEMS?

DID ELECTRIC FIRE ALARM TEST SATISFACTORILY?

VALVE TAMPER MONITORING?

SYSTEM TRIPPED IN:

YES NO N/A

N/A

Rev 1/2014

N/A

AIR COMPRESSOR REFILLS SYSTEM IN 30MINUTES?

ALARM LINE VALVE LEFT IN OPEN POSITION?

YES

TRIP TEST (FULL) DONE?

(REQUIRED EVERY 10 YRS)

(CIRCLE ONE)

YES

COMPANY:

N/A

(REQUIRD EVERY 3 YEARS)

ALARMS

YES NO YES NO

TYPE OF TEST:

CERTIFICATION GIVEN: Valley Regional Fire Authority

YES FLOW SWITCHES, SUPER- VISORY SWITCHES, AND ALARM BELL TESTED?

FLOW PRESS:

FIRE SPRINKLER

PREACTION DELUGE

TRIP TEST (DRY TRIP) CONDUCTED? FLOW TEST CONDUCTED?

SYSTEM INSPECTED AND LUBRICATED?

SECONDS

N/A

ACCEPTANCEMONTHLY

DRY SYSTEM

NOYES

Descriptive Location:

NO N/A

FLOW TEST CONDUCTED?

STATIC PSI: FLOW PSI:

SYSTEM OF

ALARM BELL OPERATES?

WET SYSTEM

WHITE YELLOW

PAGE 1/2

TIME IN:

TIME OUT:

ARE ALL SPRINKLER CONTROL VALVES PROPERLY IDENTIFIED WITH APPROPRIATE SIGNAGE?

YES

RED

YES NO

Rev 1/2014

TECHNICIAN NAME :

THE WASHINGTON ADMINISTRATIVE CODE (WAC) 212-80-175 WAS MODIFIED IN 2005 TO REQUIRE ANY PERSON THAT OFFERS TO CONTRACT TO PROVIDE INSPECTION AND TESTING OF WATER BASED FIRE PROTECTION SYSTEMS TO BE

STATE CERTIFIED TO A MINIMUM OF NICET INSPECTION, TESTING, AND MAINTENANCE LEVEL 2. THIS IS TO CERTIFY THAT TESTS AND INSPECTIONS CONDUCTED AND DENOTED IN THIS REPORT ARE IN ACCORDANCE WITH THE STANDARDS ADOPTED BY THE WASHINGTON STATE BUILDING CODES COUNCIL AND THE WASHINGTON STATE FIRE

MARSHAL. TESTS AND INSPECTIONS REQUIRED BY THIS EVALUATION HAVE BEEN CONDUCTED IN ACCORDANCE WITH NFPA 13 AND NFPA 25.

SIGN :

SYSTEM TAGGED : RED YELLOW

SPARE STOCK OF SPRINKLER HEADS AND WRENCH AVAILABLE?

FIRE DEPARTMENT CONNECTIONS FREE FROM OBSTRUCTIONS?FIRE DEPARTMENT CONNECTION CAPS IN PLACE AND SECURE?

HAVE THERE BEEN ANY CHANGES TO THE OCCUPANCY SINCE THE LAST INSPECTION?SYSTEM SPRINKLER HEADS INSPECTED FOR PROPER PLACEMENT AND DAMAGE?

IF HYDRAULICALLY DESIGNED, ARE RISERS PROPERLY MARKED PER NFPA 13?

GENERAL

QUICK RESPONSE HEADS LESS THAN 20 YEARS OLD?

GAUGES CHECKED FOR CALIBRATION OR REPLACED? (EVERY 5 YEARS)

SYSTEM LEFT IN SERVICE?

PAGE 2/2

GPMPSI

CORRECTIONS MADE: YES

STATIC:

COMMENTS

TEMPERATURE - ARE SPRINKLERS THE PROPER TEMPERATURE RATINGS FOR THEIR LOCATIONS?

ACCEPTABLE DRAIN TEST?

DRY TYPE HEADS LESS THAN 10 YEARS OLD?

RECORD WATER PRESSURE AT RISER:

NO N/A

SIZE OF VALVE:

NO

INCH

YES NO N/A YES

ARE ALL SPRINKLERS FREE FROM CORRO- SION, LOADING OR OBSTRUCTION TO SPRAY DISCHARGE?

RESIDUAL: PSI

STANDARD RESPONSE HEADS LESS THAN 50 YEARS OLD?

IS THE SYSTEM HYDRAULICALLY DESIGNED?

IS THE SPRINKLER SYSTEM FREE OF ANY RECALLED HEADS OR DEVICES?