Fillable Fire Alarm Inspection Report (City of Oakland)

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Fire Alarm Inspection Report (City of Oakland)

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Country of origin: US
File type: PDF

U.S.A. forms for City of Oakland

BROWSE CITY OF OAKLAND (CA) FORMS

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Fire Alarm Inspection Report
Customer Name
Supervising Station Monitoring
Deciencies, Comments, and Recommendations
Notes:
Monitoring Notied
Pass
Type TypeVoltage Voltage
Fail
Pass Pass
N/A
Fail Fail
Time
Time Inspection Begin Time Inspection End
Inspection Company
Final Result / Tag Color
Customer Phone
Management Notied
Inspection Date
Point of Contact
Email Address
Occupants Notied
Other
Inspectors Name
Service Interval
Customer Address
Inspection Company
Address
Alarm Signal
Alarm Restoration
Trouble Signal
Supervisory Signal
Trouble Signal Restoration
Supervisory Signal Restoration
Primary Power Secondary Power
Nominal Voltage
Amp-Hr Rating
N/A N/A
N/A
Over-current Protection Amps Engine-Driven Generator
Over-current Protection Disconnection
Amps
Calculated Capacity
Over-current Protection Type
Amp-Hrs to operate
Hrs
Over-current Protection Location
Location of fuel storage
Battery Location Battery Location
Monitoring Company
Monitoring Information
Transmission Type
Transmission Type
Number of Circuits
Building Occupant Contact
Circuit Styles
Last Software Revision
Communicator Brand
Monitoring Phone
Cntrl Unit Manufacturer
Software Rev
Building Management Contact
AHJ notied of impairments
Monitoring Account #
Model Number
Date of Last Service
Communicator Type
AHJ Contact
N/A
N/A
COMMUNITY CARE OF LEMAY
ST. LOUIS MO 63125
314-631-0564
LARRY / DIANE
DBALMER@COMMUNITYCAREMIDWEST.COM
GREEN
MARMIC FIRE & SAFETY
ST. LOUIS MO 63125
06/02/2020
M. REINKEMEYER
SEMI-ANNUAL
CMS
800-631-2299
SLNF10045
12:30
12:30
12:15
1:15
DACT
ADVANCED
AXCTL1
B
2
12/2019
DACT
ADVANCED
12:30
12:31DACT
120
12V7AH
12
CB
24
20
CB
CB
FACP
LA
13.56
FACP
LA
13.57
9353 S. BROADWAY
11694 LACKLAND RD.
Initiating Devices
Combination Systems
Special Hazard System
System Tests
Signaling Line Circuits
Notication Appliance Circuits
Manual Alarm Boxes
Fire Ext. Monitoring Visual
Visual
Control Unit
Quantity of Signaling Line Circuits
Installed
Pass
Pass
Visual
Tested
Fail
Fail
N/A
N/A
Functional
N/A
N/A
N/A
N/A Notes
Duct Detectors
CO2 System Operation
Fuses
CO2 Detectors
Ground Fault Monitoring
Waterow Switches
Trouble Signals
Other:
Other:
Ion Detectors
Fire Ext. Monitor Operation
Device Operation
Interface Equipment
Style of Signaling Line Circuits
Photo Detectors
CO2 System Visual
Special Procedures
Lamps/LED’s
Supervisory Switches
Disconnect Switches
Heat Detectors
Other:
Primary Power Supply
Kitchen Hood
Building Temperature
Fire Pump Power
Other:
Fire Pump / Controller Trouble
Other:
Site Water Temperature
Site Water Level
Generator in Auto Position
Fire Pump Running
Other:
Notication Devices
Device Notes
Customer Signature Inspectors SignatureDate Date
Bells
Installed
Tested
N/A
Chimes
Speakers
NAC Expanders
Number of Alarm Circuits
Door Holders
Other:
Other:
NACs Monitored for Integrity
Horns
Horn Strobes
Strobes
Aux Relays
Devices and Circuit Information
Emergency Communication
Phone Set
PassQty
Fail N/A
Ampliers
Call-In Signal
Phone Jacks
O-Hook Indicator
Tone Generators
This system has been inspected and tested according to NFPA 72
4
Y
10
10
57
57
4
4
2
2
1
1
1
1
2
YES
8
8
06/02/2020
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Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
PHOTO
110
✔
✔
PHOTO
109
✔
✔
PHOTO
BY 108
✔
✔
PHOTO
108
✔
✔
PHOTO
107
✔
✔
PHOTO
106
✔
✔
PHOTO
BY 106
✔
✔
PHOTO
105
✔
✔
PHOTO
104
✔
✔
PHOTO
BY 104
✔
✔
PHOTO
103
✔
✔
PHOTO
102
✔
✔
PHOTO
101
✔
✔
PHOTO
BY FACP
✔
✔
PHOTO
BY 210
✔
✔
PHOTO
210
✔
✔
PHOTO
209
✔
✔
PHOTO
208
✔
✔
PHOTO
207
✔
✔
PHOTO
206
✔
✔
PHOTO
BY 206
✔
✔
PHOTO
205
✔
✔
PHOTO
204
✔
✔
PHOTO
203
✔
✔
PHOTO
202
✔
✔
PHOTO
BY 202
✔
✔
PHOTO
201
✔
✔
PHOTO
312
✔
✔
PHOTO
311
✔
✔
PHOTO
310
✔
✔
PHOTO
BY 310
✔
✔
PHOTO
309
✔
✔
PHOTO
308
✔
✔
PHOTO
307
✔
✔
PHOTO
306
✔
✔
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
PHOTO
BY 306
PHOTO
305
PHOTO
304
PHOTO
303
PHOTO
302
PHOTO
BY 302
PHOTO
301
PHOTO
300 HALL BY CLEAN LINEN
PHOTO
BY LAUNDRY
PHOTO
BY KITCHEN
PHOTO
BY BREAK RM
PHOTO
BY JANITOR
PHOTO
DINING
PHOTO
DINING
PHOTO
DINING
PHOTO
DINING
PHOTO
DINING
PHOTO
DINING
PHOTO
BY ADMIN
PHOTO
LOBBY
PHOTO
BY PHYS. THERAPY
MPS
100 HALL EXIT
MPS
200 HALL EXIT
MPS
300 HALL EXIT
MPS
BY FACP
MPS
KITCHEN EXIT
MPS
DINING EXIT
MPS
DINING EXIT
MPS
BY BREAK RM
MPS
MAIN ENTRANCE
MPS
400 HALL EXIT
HEAT
MECH. RM
HEAT
KITCHEN
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
DUCT
SOILED UTILITY 100
DUCT
SOILED UTILITY 100
DUCT
MECH. RM
DUCT
MECH. RM
FLOW
RISER
TAMPER
RISER
H/S
100 HALL
H/S
200 HALL
H/S
300 HALL
H/S
400 HALL
H/S
400 HALL
H/S
DINING
H/S
KITCHEN
H/S
KITCHEN
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
Zone Device Type Device Location Visual Functional Model Sensitivity Range Sensitivity Result Notes Pass Fail
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Fire Alarm Inspection Report (City of Oakland)

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Completed 13 September 2021

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