***DO NOT MAIL THIS FORM***
TP_015_F Fire Alarm System Deficiency Form
Fire Alarm System Deficiency Report
When deficiencies are not corrected within 45 days of the certification inspection or testing, the
Contractor must submit this deficiency report to the Department of Licenses and Inspections.
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Address: ___________________________________________________________________________________
Name: _____________________________________________________________________________________
Address: ___________________________________________________________________________________
Email: _______________________________________________ Phone: ______________________________
Agent Information
Provide the contact information for
the building owner/owner’s agent.
Provide the address of the
property where the deficiency is
Information
Provide the names of the
Contractor and fire alarm inspector.
Contractor Name: ____________________________________________________________________________
Fire Alarm Inspector Name: ____________________________________________________________________
Date of Inspection: _____________________________
(A) Provide information on any
minor deficiencies.
N
ote: The sections noted are
referenced from the Fire
Alarm System Certification
Form (TP_009_F).
(B) P
rovide information on any
major deficiencies.
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(A) Minor Deficiencies Identified:
☐
☐
☐
Section 4:
☐
Any modifications to system since last inspection (explain): ________________________________________________________________
_________________________________________________________________________________________________________________
Section 5:
☐
Fire control is not accessible
☐
Remote annunciator did not test satisfactory
☐
Battery charging circuit is not operating and/or at proper voltage
☐
Control panel supervision did not test satisfactory
☐
Ground fault monitoring did not test satisfactorily
☐
Test of control lamps, LED’s interface equipment, audible/visible
trouble & alarm signals not satisfactory
Section 6:
☐
Signs missing and/or manual fire alarm boxes did not test
satisfactory
☐
Water flow switch tests not satisfactory
☐
Smoke detector inspection/tests, thermal elements, control
output not acceptable
☐
Valve, tampers, low temperatures and/or low air pressure not
satisfactory
☐
Non-restorable and restorable heat detectors not satisfactory
☐
Fire pump running, trouble and/or alternate power tests not
satisfactory
☐
Alarm verification not satisfactory
☐
Range hood / other suppressions system not interconnected and/or
not satisfactory
☐
Smoke detectors not tested according to NFPA 72
☐
Air handler duct smokes not interconnected properly
☐
Duct smoke detector tests not satisfactory
Section 7:
☐
Visible alarms not satisfactory
☐
Elevator interface and/or detection not satisfactory
☐
Sound levels not satisfactory
☐
Door hold open devices not satisfactory
☐
Air handlers over 2000 cfm shutdown unacceptable
☐
Electronically locked egress doors not satisfactory
Section 8:
☐ Primary power source not satisfactory
☐ NAC power supplies not satisfactory
☐ Secondary power source not satisfactory
☐ Additional controls, etc. not satisfactory
Section 9:
☐
Fire fighter phone systems not satisfactory
☐
Monitoring not UL approved
☐
Daily test & two telephone lines/monitoring not satisfactory
☐
Monitoring test not satisfactory
(B) Major Deficiencies Identified: ☐None ☐Checked Below ☐Other
☐
☐
More than 10% of initiating device failed or missing
☐
☐
More than 10% of notification devices failed or missing
☐
F.A.C.P. in trouble with system impairment
☐
Firefighter phones inoperative or missing
☐ System monitoring out-of-service
☐ Elevator recall inoperative
☐
Other (describe): _______________________________________________________________________________________________
_______________________________________________________________________________________________________________
Upload completed forms through the “Submit an
Annual Certification Report” option in eCLIPSE.
The Deficiency Form must be presented by the Contractor to the building owner/agent upon completion. By signing below, I certify that the above Fire Alarm System,
tested in accordance with NFPA 72 and the Philadelphia Fire Code, failed the annual inspection. Systems out of service must be reported immediately to the Philadelphia
Fire Department at 215-922-6000.
Signature of Inspector: ___________________________________________________________ Date: _________________________
S
ignature of Building Owner/Owner’s Agent: _________________________________________ Date: _________________________
