Fillable FIRE ALARM INSPECTION AND TESTING FORM (Incorporated Village of Sag Harbor)

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FIRE ALARM INSPECTION AND TESTING FORM (Incorporated Village of Sag Harbor)

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  • 115 check-boxes
  • 49 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Incorporated Village of Sag Harbor

BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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C:\Users\czaino\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\TPZS3A6N\Fire Alarm Inspection ATTACHMENT 3.doc 21Jul10
FIRE ALARM INSPECTION AND TESTING FORM
SERVICE COMPANY
CUSTOMER
NAME
NAME
_______________________________
ADDRESS
ADDRESS
_______________________________
CITY/STATE/ZIP
OWNER CONTACT
_______________________________
REPRESENTATIVE
_______________________________
TELEPHONE
_______________________________
LICENSE NO.
_______________________________
TODAY’S DATE
_______________________________
TELEPHONE
_______________________________
START TIME
_______________________________
MONITORING COMPANY
CONTROL UNIT
NAME
_______________________________
MANUFACTURER
_______________________________
TELEPHONE
_______________________________
MODEL
_______________________________
ACCOUNT NO.
_______________________________
LAST SERVICE DATE
_______________________________
QUANTITY CLASS
________
A B
MANUAL FIRE ALARM BOXES
________
A B
ION DETECTORS
________
A B
PHOTO DETECTORS
________
A B
DUCT DETECTORS
________
A B
HEAT DETECTORS
________
A B
WATERFLOW SWITCHES
________
A B
BELLS
________
A B
HORNS
________
A B
STROBES
________
A B
SPEAKERS
________
A B
SPRINKLER VALVE SUPERVISORY
________
A B
SPRINKLER TAMPER SUPERVISORY
________
A B
BUILDING TEMPERATURE SUPERVISORY
OVER
OFFICE OF CODE
ENFORCEMENT
Village of Sag Harbor
55 Main St., PO Box 660
Sag Harbor, N.Y. 11963
631-725-2804
631-725-4852 fax
SYSTEM POWER SUPPLY
BATTERIES
DEDICATED CIRCUIT YES NO
DATE OF BATTERY
INSTALLATION OR “UNKNOWN”
DATE:________________
PANELBOARD AND CIRCUIT
DESIGNATION
_____________________
CHARGER TEST PASS FAIL UNK
CIRCUIT NUMBER IS LABELED ON
FIRE ALARM CONTROL UNIT
YES NO
LOAD VOLTAGE PASS FAIL UNK
DISCONNECTING MEANS IS
SECURED
YES NO
DISCHARGE TEST PASS FAIL UNK
DISCONNECTING MEANS IS
CLEARLY LABELED
YES NO
BATTERY CONDITION
ACCEPTIBLE
UNACCEPTIBLE
NOTIFICATIONS ARE MADE PRIOR TO ANY TESTING
MONITORING ENTITY YES NO
TIME:____________
BUILDING OCCUPANTS YES NO
TIME:____________
BUILDING MANAGEMENT YES NO
TIME:____________
FIRE MARSHAL YES NO
TIME:____________
DEVICE TEST TYPE COMMENTS
CONTROL UNIT VISUAL FUNCTIONAL
________________________________________________________
LAMPS/LEDs VISUAL FUNCTIONAL
________________________________________________________
TROUBLE SIGNALS VISUAL FUNCTIONAL
________________________________________________________
AUDIBLE NOTIFICATION
DEVICES
VISUAL FUNCTIONAL
________________________________________________________
VISIBLE NOTIFICATION
DEVICES
VISUAL FUNCTIONAL
________________________________________________________
TELEPHONE LINE(s) VISUAL FUNCTIONAL
________________________________________________________
DEVICE LOCATION DEVICE TYPE TEST TYPE RESULTS
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
VISUAL FUNCTIONAL PASS FAIL
HAVE ANY DEVICES BEEN ADDED OR REMOVED SINCE THE LAST INSPECTION? YES NO
IS THE FIRE ALARM CONTROL UNIT PROTECTED BY A SMOKE DETECTOR? YES NO
WAS THE TRANSMISSION OF ALARM EVENTS TO THE MONITORING ENTITY CONFIRMED? YES NO
HAVE THE FOLLOWING BEEN NOTIFIED THAT TESTING IS COMPLETE? MONITORING AGENCY YES NO
BUILDING OCCUPANTS YES NO
BUILDING MANAGEMENT YES NO
FIRE MARSHAL YES NO
IS THE SYSTEM FUNCTIONING NORMALLY? YES NO
IS THE SYSTEM MONITORED? YES NO
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH NFPA 72
NAME OF INSPECTING
TECHNICIAN
_______________________________
NAME OF OWNER OR
REPRESENTATIVE
_____________________________
TECHNICIAN’S
SIGNATURE
_______________________________
OWNER OR REPRESENTATIVE
SIGNATURE
_____________________________
DATE:______________
TIME:________________
DATE:_____________________
TIME:________________
ATTACH CENTRAL STATION’S LOG OF THE TEST TO THIS REPORT AND RETURN TO:
SAG HARBOR VILLAGE CODE ENFORCEMENT, PO BOX 660, SAG HARBOR, NY 11963
TEL 631-725-2804 FAX 631-725-4852
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FIRE ALARM INSPECTION AND TESTING FORM (Incorporated Village of Sag Harbor)

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Completed 16 July 2020

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