Fillable RANGE HOOD FIRE SUPPRESSION SYSTEM REPORT CUSTOMER ADDRESS (City of Oakland)

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RANGE HOOD FIRE SUPPRESSION SYSTEM REPORT CUSTOMER ADDRESS (City of Oakland)

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  • 96 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

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RANGE HOOD FIRE SUPPRESSION SYSTEM REPORT
DATE:
WORK ORDER #:
CUSTOMER
ADDRESS
CITY / STATE
CONTACT
EMAIL
SERVICE TYPE
PHONE
MANUFACTURER LOCATION OF SYSTEM
MODEL SERIAL #
SIZE OF SYSTEM
NEXT HYDROSTATIC MAINTENANCE DATE
(YYYY)
# OF CYLINDERS
LIST OF APPLIANCES
AND NOZZLES ON
SYSTEM
1. All appliances properly covered with correct nozzles 18. Check positioning of fusible links and brackets
2. Duct and plenum properly covered with correct nozzles 19. All piping and conduit properly secured and braced
3. All nozzles properly postiioned 20. Proper separation between fryers and open flame
4. System installed in accordance with manufacturer's UL listing 21. Proper clearance between open flame and filters
5, All hood penetrations sealed with weld or UL listed device 22. Exhaust fan in operating order
6. Upon arrival, check if all seals are intact 23. All hood filters replaced upon completion
7. Upon arrival, has system been discharged 24. Gas valves in on or open position
8. All pressure gauges in proper range 25. Electrical microswitches reset
9. Cartridge weight checked 26. Manual/Remote pull stations reset and seals in place
10. Cylinder and cabinets properly mounted 27. System covers put back in place
11. System operated from terminal link 28. System operational and seals in place
12, System operated from remote pull station 29. Fan warning sign on hood
13. Electrical microswitches operated properly 30. Personnel instructed on manual operation of sytem
14. Gas valves operated properly 31. Proper hand portable extinguishers in place
32. Portable extinguishers properly serviced
15. Nozzles clean and proper covers in place 33. New service and certification tag placed on system
16. Piping clear of obstructions/ purged with air 34. System UL-300 compliant
17. Replaced fusible links
888-462-7642
500
450 360
#1size
#2size
#3size
YES NO N/A
YES NO N/A
other:
SEMI-ANNUAL INSPECTION
0
0
0
0
N/A
N/A
N/A
COMMENTS:
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA17, 17A, and the
manufacturer's manual and was operated according to these procesures with results indicated above.
Customer's authorized agent
DATE
signature
I state the information on this form is correct at the time and place
of my inspection,and that all equipment tested at this time was left
in operational condition upon completion of this inspection or
testing except as noted.
Service technician
LICENSE
signature
I state the information on this form is correct at the time and place
of my inspection,and that all equipment tested at this time was left
in operational condition upon completion of this inspection or
testing except as noted.
The above technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
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RANGE HOOD FIRE SUPPRESSION SYSTEM REPORT CUSTOMER ADDRESS (City of Oakland)

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Completed 5 November 2021

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