1-
888-462-7642
Report of Inspection &
Testing
of Dry Pipe Fire Protection Systems
Monthly and/or Quarterly Items to be
Reviewed
ALL QUESTIONS ARE TO BE FULLY ANSWERED AND ALL BLANKS TO
BE FILLED
Customer
Job #
Address
Inspector Name
Date
Inspection Frequency: Monthly Quarterly Annually Other
All “NO” answers must be fully explained.
Inspector’s Initial
Owner/Designate Rep. Initial
Date
I acknowledge that the listed deficiencies have
been discussed with me and that I am requesting
a quote for the repair of said deficiencies.
Owner/Designated Representative
Annual Inspection of Dry Pipe
Sprinkler System
Dry Pipe Sprinkler System
Inspection
13.4 Air pressure gauge psi
13.4 Accelerate or quick opening device gauge psi
13.4 Water pressure gauge psi
13.4 Water supply gauge psi
Y N/A N
13.3 System in service on inspection
13.3 Trim valves in appropriate position
13.3 Alarm test valve closed
13.5 Intermediate chamber leak tight
13.4 Valve enclosure secured
13.4 Heater operational
13.4 Compressor operational
13.4 Oil level full
13.4 High/low pressure switches operational
13.4 Auto, air maint. devices operational
13.3 Control valve locked/tamper open
13.3 Backflow valve locked open/tamper
13.3 Valve area accessible
13.3 Control valves accessible
13.3 Main check valve holding pressure
13.7 FDC plainly visible
13.7 FDC easily accessible
13.7 FDC swivels non-binding rotation
13.7 FDC caps/plugs in place
13.7 FDC gaskets/signs in place
13.7 FDC ball drip drain drip free
5.1 Exterior alarms properly identified
5.2 Extra heads in spare head cabinet
5.2 Heads appear to be proper temperature
5.2 Head wrench for each type of head
5.2 Head in cooler appears free of ice,
corrosion
5.2 Head appears free of leakage or damage
5.2 Head appears free of paint
5.2 Head appears free of non-approved
coverings
5.3 Standard head less than 50 year
5.3 Residential head less than 20 year
5.1 Low point drum drips drained (as
frequently as needed)
4.1 All valves identified with signage
5.2 Hydraulic nameplate attached
5.1 Alarm panel clear
System in Service
Comments
Y N/A N
13.4 Quick opening devices tested during
semi-annual inspections
13.4 Quick opening device test date
________________________
13.4 Priming water at proper level
13.2 Sprinkler supply gauge with
main drain flow psi
Y N/A N
13.4 Gauges operating
13.2 Interior building alarms operate
13.2 Exterior alarms operate
5.1 Did alarm supervisory company receive
signal?
5.1 Did alarm panel reset?
Comments:
Quarterly Testing
Requirements for a Dry Pipe
Sprinkler System
Y N/A N
13.4 Inspect interior of strainers, fillers,
restricted orifices every 5th year
Date
13.4 Inspect interior of main check valve
every 5th year Date
5.2 Visual inspection: hanger/seismic
bracing appears attached and secure
5.2 Visual inspection: “exposed” piping
appears in good condition
5.2 Piping appears free of mechanical
damage
5.2 Piping appears free of leakage
5.2 Piping appears free of corrosion
5.2 Piping appears properly aligned
5.2 Piping appears free of external loads
5.2 Sprinklers appear free of corrosion
5.2 Sprinklers appear properly positioned
5.2 Sprinklers appear properly spaced
5.2 Sprinklers appear free of foreign material
5.2 Sprinkler spray patterns appear free of
obstructions
Comments:
Annual Testing & Maintenance Tasks that are in Addition to
Other Frequency Tasks - For Dry Pipe System
Y N/A N
13 Dry pipe valve (annually)
13.4 Dry pipe valve trip tested with control
valve partially open Date _______________
13.4 Full flow 3 year trip test Date _______________
(Exception: When protecting a cooler or heater, DO NOT introduce
moisture into system.)
Y N/A N
13.4 Information on last trip test recorded
13.3 Control valve operated to closed
position and returned to open position
13.3 Backflow assembly control valves
operated and return to open position
13.3 Post indicator valve operated with
______ number of turns recorded
13.3 Post indicator valve returned to open
position
(All above listed control valves to be left 1/4 turn from wide open.)
14.2 Internal pipe inspection recommended
Comments:
Y N/A N
Test Frequency items of 5 Years Unless Noted
5.3 Gauge maintenance test (5 year)______
5.3 Replaced date
5.3 Calibrated date
5.3 Sprinkler maintenance test frequencies
5.3 (5 year) high temp. Date____________
5.3 (20 year, then 10 year thereafter)
Fast response date _________________
5.3 (50 year, then 10 year thereafter)
Standard sprinkler date _____________
F-4.1 Supplemental Information on Dry Pipe Valve and
System Condition Report (Annual)
Dry systems controls sprinklers in:
D.P.V. trip test satisfactory
Reason or failure/or partly satisfactory:
13.4 Condition: interior of body in good
condition
13.4 Condition: moving parts in good condition
13.4 Condition: seats in good condition
13.4 Condition: rubber facing in good condition
13.4 Q.O.D. operation indicate satisfactory
13.4 Q.O.D. operation indicate failed
13.4 Q.O.D. operation indicate shut off
Trip
Test
Table
If No, explain:
Dry pipe
operating
test
Dry Valve Size Year Q.O.D. Year
Make Model Serial No. Make Model Serial No.
Min Sec psi psi psi Min Sec Yes No
Without Q.O.D.
With Q.O.D.
Time water
Time to trip Water Air Trip Point reached Alarm
thru test pipe Pressure Pressure Air Pressure test outlet Operated
SYSTEM ID
Office
124 EAST SOUTH SERVICE ROAD
