A-1 Fire Alarm System Inspection Y N/A N
A-1.1
System NORMAL Upon Arrival
A-1.2 System Monitored by Central Station
A-1.3 Notifications Made Prior to Testing
B-1 Control Unit Inspection
B-1.1 Control Unit Transmission Type
B-1.2 Control Unit Manufacturer
B-1.3 Control Unit Model Number
B-1.4 Control Unit Circuit Styles
B-1.5 Number of Circuits
B-1.6 Software Revision
B-1.7 Date of Last Service
C-1 Initiating Devices and Circuit Information Qty. Style Visual
C-1.1 Smoke Detectors (Ionization)
C-1.2 Smoke Detectors (Photoelectric)
C-1.3 Manual Fire Alarm Pull Stations
C-1.4 Duct Detectors
C-1.5 Heat Detectors
C-1.6 Waterflow Switches
C-1.7 Pressure Switches
C-1.8 Supervisory Switches
C-1.9 Projected Beam Smoke Detectors
D-1 Notification Appliances & Circuit Information Qty. Style Visual
D-1.1 Bells
D-1.2 Horns
D-1.3 Chimes
D-1.4 Strobes
D-1.5 Speakers
D-1.6 Combination Horns/Strobes
D-1.7 Combination Chime/Strobes
D-1.8 Combination Speaker/Strobes
Qty. Style
E-1 Signaling Line Circuit(s) Information
F-1 System Power Supplies Type Loc. Voltage
F-1.1 Primary (Main)
F-1.2 Overcurrent Protection
F-1.3 Disconnection Means Location
F-1.4 Secondary (Standby)
F-1.5
Storage Batteries (AHR)
F-1.6 Engine Driven Generator
F-1.7 Fuel Storage
G-1 System Tests and Inspection Visual Funct.
G-1.1 Control Unit
G-1.2 Interface Equipment
G-1.3 Lamps/LEDs/LCD Readout
G-1.4 Fuses/Breakers
G-1.5 Primary Power Supply
G-1.6 Trouble Signals
G-1.7 Disconnect Switches
G-1.8 Ground-Fault Monitoring
G-1.9 Battery Condition
G-1.10 Load Test
G-1.11 Discharge Test
G-1.12 Charger Test
G-1.13 Transient Suppressors
G-1.14 Remote Annunciators
H-1 Notification Appliance Testing Visual Funct.
H-1.1 Audible
H-1.2 Visual
H-1.3 Speakers
H-1.4 Clarity
I-1
In
itiating Device Location
Visual Funct. Type
Device#
I-1.1
I-1.2
I-1.3
I-1.4
I-1.5
I-1.6
I-1.7
I-1.8
I-1.9
I-1.10
I-1.11
I-1.12
I-1.13
I-1.14
I-1.15
I-1.16
I-1.17
I-1.18
I-1.19
I-1.20
I-1.21
I-1.22
I-1.23
I-1.24
I-1.25
J-1
Monitored Systems
Visual Funct.
J-1.1
J-1.2
J-1.3
J-1.4
J-1.5
K-1 Supervising Station Monitoring Y N Time
K-1.1 Alarm Signal Received
K-1.2 Alarm Restored
K-1.3 Trouble Signal Received
K-1.4 Trouble Signal Restored
K-1.5 Supervisory Signal Received
K-1.6 Supervisory Signal Restored
L-1 Notifications that Testing is Complete Y N Time
L-1.1 Building Management
L-1.2 Building Occupants
L-1.3 Monitoring Entity
L-1.4 Other (Specify)
Date Time
M-1 System Restored to Normal Operation
Comment Section
Report of Inspection & Testing
of Fire Alarm Systems
ALL QUESTIONS ARE TO BE FULLY ANSWERED AND ALL BLANKS TO BE FILLED
Customer
Inspector(s) Name
Date
Inspection Frequency: Monthly Quarterly Semi-annual
Annual
(
All deficient answers to be fully explained)
Date
Inspector's Signature
Owner or Designated
Rep. Signature
1-888-462-7642
Other:
N/A
N/A
N/A
N/A
N/A
N/A
ADDR
ESS
DATE
LICENSE CERTS:
(
PASS/FAIL)
(
PASS/FAIL)
(
PASS/FAIL)
Cracker Barrel 590 - Sullivan, MO
701 West Springfield Road
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
