Test Report Form

8/13/2019 Test Report Form

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FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM

To be completed by the system inspector or tester at the time of the inspection or test.

It shall be permitted to modify this form as needed to provide a more complete and/or clear record.Insert N/A in all unused lines.

Attach additional sheets, data, or calculations as necessary to provide a complete record.

Date of this inspection or test: Time of inspection or test: 1. PROPERTY INFORMATION

Name of property: Address: Description of property: Occupancy type:

Name of property representative: Address: Phone:

Fax:

E-mail:

Authority having urisdiction over this property: Phone: Fax: E-mail:

2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION

!ervice and"or testing organi#ation for this e$uipment: Address: Phone: Fax: E-mail: !ervice technician or tester: %ualifications of technician or tester:

A contract for test and inspection in accordance &ith NFPA standards is in effect as of: The contract expires: 'ontract num(er: Fre$uency of tests and inspections: )onitoring organi#ation for this e$uipment: Address: Phone: Fax: E-mail: Entity to &hich alarms are retransmitted: Phone:

3. TYPE OF SYSTEM OR SERVICE

Fire alarm system *nonvoice+Fire alarm &ith in-(uilding fire emergency voice alarm communication system *E,A'!+

)ass notification system *)N!+

'om(ination system &ith the follo&ing components:

Fire alarm E,A'! )N! T&o-&ay in-(uilding emergency communication system

Other *specify+:

NFPA 72,Fig. 14.6.2.4 (p. 1 of 11)

Copyright 2009 National Fire Protection Aociation. !hi for" "ay #e copie$ for in$i%i$&al &e other than for reale. 't "ay not #e copie$ for co""ercial ale or $itri#&tion.


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3. TYPE OF SYSTEM OR SERVICE(continued)

NFPA 72 edition: Additional description of system*s+: 3.1 Control Unit

)anufacturer: )odel num(er: 3.2 Ma Noti!i"ation S#t$% !hi yte" $oe not incorporatean N.

3.2.1 System Type:

.n-(uilding )N!/com(ination

.n-(uilding )N!/stand-alone 0ide-area )N! Distri(uted recipient )N!

Other *specify+: 3.2.2 S#t$% F$at&r$'

'om(ination fire alarm")N! )N! A'1 only 0ide-area )N! to regional national alerting interface

2ocal operating console *2O'+ Direct recipient )N! *D3)N!+ 0ide-area )N! to D3)N! interface

0ide-area )N! to high-po&er spea4er array *5P!A+ interface .n-(uilding )N! to &ide-area )N! interface

Other *specify+: 3.3 S#t$% Do"&%$ntation

An o&ner6s manual a copy of the manufacturer6s instructions a &ritten se$uence of operation and a copy of the record

record dra&ings are stored on site7 2ocation: 3.( S#t$% So!t)ar$ !hi yte" $oe not ha%e altera#le ite*pecificoft+are.

!oft&are revision num(er: !oft&are last updated on: A copy of the site-specific soft&are is stored on site7 2ocation:

(. SYSTEM PO*ER

4.1 Control Unit

4.1.1 Primary Power

.nput voltage of control panel: 'ontrol panel amps: (.1.2 En+in$Dri-$n G$n$rator !hi yte" $oe not ha%e agenerator.

2ocation of generator: 2ocation of fuel storage: Type of fuel: (.1.3 Unint$rr&ti/l$ Po)$r S#t$% !hi yte" $oe not ha%e aP.

E$uipment po&ered (y a 1P! system: 2ocation of 1P! system: Calc&late$ capacity of P #atterie to $ri%e the yte" co"ponent connecte$ to it-

.n stand(y mode *hours+: .n alarm mode *minutes+:

NFPA 72,Fig. 14.6.2.4 (p. 2 of 11)



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(. SYSTEM PO*ER (continued)

4.1.4 Batteries

2ocation: Type: Nominal voltage: Amp"hour rating: 'alculated capacity of (atteries to drive the system:

.n stand(y mode *hours+: .n alarm mode *minutes+: 8atteries are mar4ed &ith date of manufacture7

4.2 In-Building ire !mergen"y #oi"e $larm Communi"ation System or %ass &oti'i"ation System

This system does not have an E,A'! or )N!7

4.2.1 Primary Power

.nput voltage of E,A'! or )N! panel: E,A'! or )N! panel amps: (.2.2 En+in$Dri-$n G$n$rator !hi yte" $oe not ha%e a generator.

2ocation of generator: 2ocation of fuel storage: Type of

fuel:

(.2.3 Unint$rr&ti/l$ Po)$r S#t$% !hi yte" $oe not ha%e a P.


.n stand(y mode *hours+: .n alarm mode *minutes+: (.2.( 0att$ri$



4.3 &oti'i"ation $pplian"e Power !(tender Panels This system does not have po&er extender panels7

4.3.1 Primary Power

.nput voltage of po&er extender panel*s+: Po&er extender panel amps: (.3.2 En+in$Dri-$n G$n$rator !hi yte" $oe not ha%e a generator.

2ocation of generator: 2ocation of fuel storage:

Type offuel:

(.3.3 Unint$rr&ti/l$ Po)$r S#t$% !hi yte" $oe not ha%e a P.


.n stand(y mode *hours+: .n alarm mode *minutes+: NFPA 72,Fig. 14.6.2.4 (p. of 11)



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(. SYSTEM PO*ER (continued)

4.3.4 Batteries



. ANNUNCIATORS This system does not have annunciators7

).1 *o"ation and +es"ription o' $nnun"iators

Annunciator 9: Annunciator : Annunciator ;:

. NOTIFICATIONS MADE PRIOR TO TESTING

)onitoring o rgani#ation 'ontact: Time: 8uilding management 'ontact: Time: 8uilding occupants 'ontact: Time: Authority having urisdiction 'ontact: Time: Other if re$uired 'ontact: Time:

. TESTING RESULTS

,.1 Control Unit and elated !uipment

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

'ontrol unit 2amps"2EDs"2'Ds Fuses Trou(le signals Disconnect s&itches


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. TESTING RESULTS (continued)

,.2 Control Unit Power Supplies

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

9=-volt po&er


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,.4 &oti'i"ation $pplian"e Power !(tender Panels

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

2amps"2EDs"2'Ds Fuses Primary po&er supply !econdary po&er supply Trou(le signals


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,.) %ass &oti'i"ation !uipment (continued)

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

)N! to direct recipient )N! !ound pressure levels

Occupied >es No

Am(ient d8AAlarm d8A*attach report &ith locations valuesand &eather conditions+

!ystem intelligi(ility

'!. !T.

*attach report &ith locations valuesand &eather conditions+

Other *specify+ ,./ Two-0ay Communi"ations !uipment

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

Phone handsets Phone ac4s Off-hoo4 indicator 'all-in signal !ystem performance

!ystem audi(ility !ystem intelligi(ility 3adio communicationsenhancement system

Area of refuge communicationsystem

Elevator emergencycommunications system

Other *specify+

NFPA 72,Fig. 14.6.2.4 (p. of 11)



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,., Comination Systems

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

Fire extinguishing monitoringdevices"system

'ar(on monoxide detector"system 'om(ination fire"security system Other *specify+ ,. Spe"ial aard Systems

+es"ription 5spe"i'y6

#isual

Inspe"tion

un"tional

Test Comments

,.7 !mergen"y Communi"ations System

,isual

Functional

!imulated operation

Ensure predischarge notification appliances of special ha#ard systems are not overridden (y the )N!7!eeNFPA 72 ?7?797@797

,.18 %onitored Systems

+es"ription 5spe"i'y6

#isual

Inspe"tion

un"tional

Test Comments

Engine-driven generator Fire pump !pecial suppression systems Other *specify+

NFPA 72,Fig. 14.6.2.4 (p. of 11)



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,.11 $u(iliary un"tions

+es"ription

#isual

Inspe"tion

un"tional

Test Comments

Door-releasing devices Fan shutdo&n !mo4e management"smo4e control !mo4e damper operation !mo4e shutter release Door unloc4ing Elevator recall Elevator shunt trip )N! override of FA signals Other *specify+ ,.12 $larm Initiating +e9i"e

Device test results sheet attached listing all devices tested and the results of the testing

,.13 Super9isory $larm Initiating +e9i"e

Device test results sheet attached listing all devices tested and the results of the testing

,.14 $larm &oti'i"ation $pplian"es

Appliance test results sheet attached listing all appliances tested and the results of the testing

,.1) Super9isory Station %onitoring

+es"ription es &o Time Comments

Alarm signal Alarm restoration Trou(le signal Trou(le restoration !upervisory signal !upervisory restoration

NFPA 72,Fig. 14.6.2.4 (p. 9 of 11)



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6. NOTIFICATIONS T7AT TESTING IS COMPLETE

)onitoring o rgani#ation 'ontact: Time: 8uilding management 'ontact: Time: 8uilding occupants 'ontact: Time: Authority having urisdiction 'ontact: Time: Other if re$uired 'ontact: Time:

8. SYSTEM RESTORED TO NORMAL OPERATION

Date: Time:

19. CERTIFICATION

18.1 Inspe"tor Certi'i"ation:

This system as specified herein has (een inspected and tested according to all NFPA standards cited herein7

!igned: Printed name: Date: Organi#ation: Title: Phone: 18.2 $""eptan"e y ;wner or ;wner


11/11

DEVICE TEST RESULTS

5$tta"= additional s=eets i' reuired6

+e9i"e Type $ddress *o"ation Test esults

NFPA 72,Fig. 14.6.2.4 (p. 11 of 11)


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Test Report Form