Doc#473008
Page1of1 Ref:PS‐04.1D
Complianceschedulespecifiedsystems
Informationtobeprovided(inconjunctionwithBAForm2)
Version: 4
Date: December2019
Code: PS‐04.1D
ThischecklistshouldbeusedtoidentifyspecifiedsystemswithinbuildingsinaccordancewithBuildingAct2004.
Pleaseidentifyspecifiedsystemsbytickingappropriateboxes.Pleaseincludecopiesoftheindividualspecified
systemsforms.Theseformscanbeaccessedviahttps://icc.govt.nz/building/sbcg‐forms/
Siteaddress: Firehazardcategory:
Buildingname: Purposegroup:
Ownersname: Totaloccupantload:
Specifiedsystems Existing Add Alter Remove
SS1‐SS16
Form
Attached
SS1 AutomaticSprinklerSystems
SS2 EmergencyWarningSystems
SS3.1 AutomaticDoorsandWindows
SS3.2 AccessControlledDoors
SS3.3 InterfacedFireorSmokeDoorsorWindows
SS4 EmergencyLightingSystems
SS5 EscapeRoutesPressurisationSystems
SS6 RiserMains
SS7 AutoBack‐FlowPreventers
SS8.1 PassengerCarryingLifts
SS8.2 ServiceLifts
SS8.3 EscalatorsandMovingWalks
SS9 MechanicalVentilation/AirConSystems
SS10 BuildingMaintenanceUnits
SS11 LaboratoryFumeCupboards
SS12.1 AudioLoops
SS12.2 FMRadioFrequencySystems
SS13.1 MechanicalSmokeControl
SS13.2 NaturalSmokeControl
SS13.3 SmokeCurtains
SS14.1 EmergencyPowerSystemsforSS1‐13
SS14.2 SignsforSS1‐13
SS15.1 SystemsforCommunicatingEvacuation
SS15.2 FinalExits
SS15.3 FireSeparations
SS15.4 Signs
SS15.5 SmokeSeparations
SS16 CableCars
Specifiedsystemsplanattached: Yes