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Please provide the following information with your Building (Accident Compensation Corporation New Zealand)

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WBCG LG-11 SS2
Version 2018-01-26
Page 1 of 2
Waikato Building Consents
Compliance Schedule Details:
SS 2 – Automatic/Manual Emergency Warning Systems (alarms)
Please provide the following information with your Building Consent Application
- Form 2
(If you need help to complete this form, consult the system provider or an IQP who is registered for the system above)
Applicant Name: ……………………………………..……..…
Site Address: ……………………………………….…………
………………………………………………………………..…
Existing Compliance Schedule Number(s): (if applicable)
…………………………………..............................................
…………………………………..............................................
Building Name: …………………………………..……………
Installation provider: (if known) ………………………………
…………………………………..............................................
Risk / Purpose group: …………………………….…………..
Fire Hazard Category: ……………………….……………….
Total Occupant Load: ……………………….………………..
SPECIFIED SYSTEM DESCRIPTION (address those items that apply)
Specified
systems:
Existing
New
Modified
Removed
Type:
Monitored non-standard School Security Warning System (SSWS)
Monitored non-standard Security Based Warning System (SBWS)
Type 2 – 7 Warning Systems (alarms) - Acceptable Solution F7/AS1, Year: ……..………..
Type 2: Manual warning systems
Type 3: Automatic fire alarm system with heat detectors and manual call points
Type 4: Automatic fire alarm system with smoke detectors and manual call points
Type 5: Automatic fire alarm system with modified smoke / heat detection and manual call points
Type 6: Automatic fire / Sprinkler alarm system with modified smoke / heat detection and manual call
points
Type 7: Automatic sprinkler alarm system with modified smoke / heat detection and manual call points
Emergency warning systems installed to manage hazardous properties of, or danger from, substances
stored or used within the premises that are governed by a Building Code clause:
A carbon monoxide gas detection system within a car park building that warms occupants of a
potentially hazardous concentration of gas
Other: [specify]…………………………………………………………………………….……………………….
Response: (i.e. Warning)
Manual
Automatic
Supplementary Devices: (i.e. detection)
Heat Detectors
Smoke Detectors
Gas Detectors
Alarm Interfacing: [specify e.g. SS1, SS3/3, SS9]
Location Plan for specified systems and records is attached:
YES
NO
No. Equipment location Make (Main components) Model
1
2
3
4
5
6
If needed cont
inue the list on another sheet of paper
Continue on nex
t the page
WBCG LG-11 SS2 Version 2018-01-26 Page 2 of 2
STANDARDS
(address those items that apply)
Specifically designed solutions do not apply if the system has been installed against a specific Standard(s) / document.
Performance /
installation:
NZS 4512, Year: ……………..
AS 1851, Year: ……..………..
Other: ………………………….
Specifically designed solution prepared by a person
who, on the basis of experience and qualifications,
is competent to do so. (Details provided)
Inspections:
NZS 4512, Year: ……………..
AS 1851, Year: …………..…..
Other: ………………………….
Specifically designed solution prepared by a person
who, on the basis of experience and qualifications,
is competent to do so. (Details provided)
Maintenance:
NZS 4512, Year: …………….
AS 1851, Year: ………………
Other: ………………………….
Specifically designed solution prepared by a person
who, on the basis of experience and qualifications,
is competent to do so. (Details provided)
INSPECTIONS, MAINTENANCE AND REPORTING
(address those items that apply)
Minimum
inspection and
maintenance
procedures:
Planned preventative maintenance and responsive maintenance will be carried out in accordance
wit
h the nominated performance and inspection Standard/document, to ensure the system will
operate as required in the event of a fire or other danger.
Inspection
frequency and
responsibility:
Specifically designed
solutions
By IQP
School Security Warning
System (SSWS):
• Monthly: by School Representative
• Six Monthly: by Security Alarm maintenance contractor
• Annual:
IQP
Security Alarm maintenance contractor
Security Based Warning
System (SBWS)
• Weekly: (sounders) by Owner / Representative
• Quarterly: (sounders & smoke detectors) by IQP only
• Annually:(sounders & smoke detectors + annual survey) by IQP
only
Manual warning systems
(Type 2f alarm)
• Monthly: (Sounders) by IQP only
• Quarterly:(Sounders) by IQP only
• Annually: by IQP only
Automatic fire alarm
system (Type 3,
4, 5, 6, 7)
• Monthly: (Sounders) by IQP only
• Quarterly:(Sounders) by IQP only
• Annually: by IQP only
Reporting:
The owner will keep records of all inspections, maintenance and repairs undertaken in the previous
24 months. These will be recorded in the On-Site Log Book, which will remain on the premises with
the most recent compliance schedule, and as a minimum include:
• Details of any inspection, test or preventative maintenance carried out, including dates,
works undertaken, faults found, remedies applied and the person who performed the work.
• Form 12A provided annually by the IQP
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Completed 7 April 2021

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