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HomeMy WebLinkAboutCF FA Inspection 2019 Fedex i- Integrated Security r. JLL. I<r..s.„„..., :Q..... P.,T.�.:,r,g rt.45.4crk. 412,:aUEoa Inspection Tour Information Date: /-47:- / Start Time: 1,z:it) End Time: / Y Inspection Job#: g5 gf 94 I V Tour Status: 6 Full ❑ Partial % Tour#: of Tours: Inspection Type: Inspection Frequency*Annual ❑ Semiannual ❑ Quarterly ❑ Bimonthly ❑ Monthly UL Type: ®\-N/A ❑ UUFX-Central Station Fire Alarm(FA) ❑ UUJS—Local Auxiliary Station,Remote Station orProprietary Station(FR) Service Organization Customer Information Name: Tyco Integrated Security Name: / _'7'e/.6-44. 6-4,,L,1-041 O /2 ze. 5y Address: .1/'4,a c. igeki d I2 v Address: ° 1 k'-r 7e14' City,ST ZIP: ,6"4 4.c Arr e.v'fl e I City,ST ZIP: j iG 4" ,r.i e 4- g 513 License No: q41? Facility Manager: Telephone: /" &Da gf')r.-- flt4-.54 7 Telephone: Monitoring Entity Authority Having Jurisdiction Contact: j Name: /7,44} Telephone: —. 04 --,-4. -j,?4,1,71 Telephone: CS#or Account#:_14,‘_ t, -52,... Transmission Type Inspection Notifications Enter the Transmission ID code for the fire alarm control panel. For more Start End information on the types of transmissions see the flip page of this booklet. Placed On Test ,-0.Yes ❑ No "_Yes ❑ No x,_:.2.-K,.4Er Yes ❑ No Yes ❑ No Type: Building Management Other(Specify): Building Staff nLYes ❑ No ,;®_Yes ❑ No Communication Tested: Primary(PCOM) EPass ❑ Fall Secondary(SCOM) :' .Pass ❑ Fail Not Monitored ❑ Fire Alarm Control Panel Information Manufacturer: ,/" f. i, Location: : v dam` " 'e1 `�' Model: /4 9,L,T,LiaK ig Floor: -/$;r-- EPROM f, }EPROM Rev: Room: `t 1. Circuit Style: Date of Last Service or Inspection Job Visit: / "~f I Number of Circuits: See page 5 to document control panel battery information. Fire Alarm Control Panel Inspection Tasks Test Performed Test Value Result Notes Visual Functional Not Tested Pass Fail AC Input Voltage 4 0` CI ❑. CI Voltage with Charger [L. '❑' CI 4,27)c '❑'" ❑ - Voltage without Charger ID LrI ^1—. CI ..,`-'77, / .,„ El - Voltage Under Max Load ®' -�� ❑ z " G ❑ Ground Faults 1 .V_ . ❑ ` L ❑ Lamps/LED Test L'T {2 ❑'_.`. ID — Drill Switch 0 ElCI ❑ lL•=- Zone Trouble 1 a ❑ _a___ CI Signal Trouble „-4 El `` ❑ Were all required signals received? Et es ❑ No Were all required signals restored? 12::-Y.es ❑ No Are all circuits supervised? I•Fes- ❑ No ©2012 Tyco Integrated Security. All rights reserved.(06/12) Page 1 of 5 Cnnfred Canal 'two Integrated Security J111111 '11 III ill it II i Fii� AI m Ii r sctior A,.-r -iiirl,0 nepc r+ gglgUPO0 Inspection Tour Information Date: fr/r-- / Start Time: ,J CC) End Time: , '4 Inspection Job#: gnfi,941 7` Tour Status: l '•Full ❑ Partial % Tour#: of Tours: Inspection Type: Inspection Frequency:,`❑-Annual E Semiannual ❑ Quarterly ❑ Bimonthly ❑ Monthly UL Type: Q\N/A ❑ UUFX-Central Station Fire Alarm(FA} ❑ UUJS-Local Auxiliary Station,Remote Station or Proprietary Station(FR) Service Organization Customer Information Name: Tyco Integrated Security Name: • 6 /4.-,,, 0 ' ' `a Address: 4,4 S'O 01e A-,;,' Address: j - ""skr 9`e/j/' A:0 City,ST ZIP: >" ( firkie.0 '6 e fzi City,ST ZIP: ir9 ..,11 C,it- 3 License No:_C,777 ''' Facility Manager: __ Telephone: / &X 4`-t24 Y 7 Telephone: Monitoring Entity - Authority Having Jurisdiction Contact: qi dName: ,} Telephone: ,/�-. g " � z 47 Telephone: CS#orAccount#:_ � b , 'i ' , Transmission Type inspection Notifications Enter the Transmission ID code for the fire alarm control panel. For more Start End information on the types of transmissions see the flip page of this booklet Placed On Test ''❑-Yes ❑ No J_Yes ❑ No Type: ; ~%" ' Building Management ziYes ❑ No ij.Yes ❑ Na Other(Specify): Building Staff Nes ❑ No ❑ Yes El No Communication Tested: Primary(PCOM) laPass ❑ Fail Secondary(SCOM) Pass ❑ Fail Not Monitored ❑ Fire Alarm Control Panel Information Manufacturer: ; ''qc. Inspection Job#f: c< tq tror II II 11111 0 Integrated Security Fire Alarm Inspection & Testing Report 8R1 WHO Impairments:(Enter Item/Model#and Manufacturer information if available.) Foran explanation of impairments,see NEPA 72. Device Type Code: Device Area: • Floor: Location: Zone/Point#: Device count on zone: of total devices on zone: Inspection Job#: Item/Model#: Manufacturer: Reason: ❑ Device Failure ❑ Damage ❑ Not to Code ❑ Device Missing ❑ Device Not Tested Action Taken: ❑Repaired ❑ Replaced Relocated Return Visit Required Device Type Code: Device Area: Floor: Location: Zone/Point#: Device count on zone: of total devices on zone: Item/Model#: Manufacturer: Reason: 0 Device Failure ❑ Damage 0 Not to Code 0 Device Missing 0 Device Not Tested Action Taken: ❑ Repaired f Replaced 0 Relocated Q Return Visit Required Device Type Code: Device Area: Floor: Location: Zone/Point#: Device count an zone: of total devices on zone: Item/Model#: Manufacturer: Reason: Device Failure Damage 0 Not to Code El Device Missing ❑ Device Not Tested Action Taken: 0 Repaired El Replaced ❑ Relocated ❑ Return Visit Required Device Type Code: Device Area: Floor: Location: Zone/Point#: Device count on zone: of total devices on zone: Item/Model#: Manufacturer: Reason: j Device Failure ❑ Damage 0 Notto Code ❑ Device Missing E Device Not Tested Action Taken: ❑ Repaired 0 Replaced El Relocated Return Visit Required Device Type Code: Device Area: Floor: Location: Zone/Point#: Device count on zone: of total devices on zone: Item/Model#: Manufacturer: Reason: 1 Device Failure ❑ Damage 0 Notto Code ❑ Device Missing ❑ Device Not Tested Action Taken: fl Repaired ❑ Replaced 0 Relocated El Return Visit Required Service Job#: _ Quote Details/Comments: El Customer authorizes service 0 Customer declines service 0 Customer requests a quote for repair work Customer Name: Signature: Date: Print First and Last Name ©2012 Tyco integrated Security. All rights reserved.(06/12) Page 2 of 5 Control Panel tgco inspection Job# 6. F Integrated security Fire Alarm Inspection &Testing Report iht_IEM Device Testing Detail Information(Enter Item/Model#and Manufacturer information if available.) Device Type Code: Signal Type: 0 Alarm "Supervisory Pathway: 17,ii Hardwired ❑Wireless/Fixed Wireless/Portable Device Area: 2t/ 6 4,1y'Vc-„Z- 7- Floor: u` Location: , • Environment: Q./indoor Outdoor Zone/Point#:/ 2ioiL Device count on zone: of total devices on zone: --- Item/Model#: ' , Manufacturer: 47 //- Action Taken(Check all that apply): QTest ElAdjust QClean Sensitivity CheckUVisual ff Functional ENot Tested(Reason): Result:prPass Fail—See the Impairment Section for details and corrective action taken. Device Type Code: d° Signal Type: AiarmAg Supervisory Pathway Hardwired 0 Wireless/Fixed ❑Wireless/Portable Device Area: Floor: Location: Environment: El Indoor Outdoor Zone/Point#:/„,„,, 2 ./ ,- Device count on zone: ,,>' of total devices on zone: Item/Model#: � Yo F. ` ,•. Manufacturer: . ; < Action Taken(Check all that apply): LTest Adjust LiClean'❑Sensitivity Check_EIVisua il.Functional❑Not Tested(Reason): Result: Q.Pass E Fail—See the Impairment Section for details and corrective action taken. Device Type Code: Signal Type: El Alarm..El Supervisory Pathway::_0 Hardwired ❑Wireless/Fixed ❑ Wireless/Portable Device Area: : :Y '°::-a: : . / -- Floor: / arm Location: ._' :'� ; / Environment: Or Indoor 0 Outdoor Zone/Point#:J?, iepoi? Device count on zone: ,,i of total devices on zone: ,f' Item/Model#: 03' 7 z,in Manufacturer: r. } Action Taken(Check all that appEy)LjTest ElAdjust OClean Sensitivity Check. Visua)rfFunctional LiNotTested(Reason): Result:4`_Pass Fail—See the Impairment Section for details and corrective action taken. Device Type Code: Signal Type: ❑ Alarrnj Supervisory'Pathway:.,.Hardwired ❑Wireless/Fixed Li Wireless/Portable Device Area: _ -' Floor: z;f-- Location: Environment:-,1:71 ❑Outdoor Zone/Point iityp Device count on zone: of total devices on.zone:• Item/Model#: t 1 , �=- r_-; ,�� ; Manufacturer: ��_ ,r t Action.Taken(Check all that apply):'Test❑Adjust QClean QSensitivity Check,QVisual,QFunctional ENotTested(Reason): • �' r Result: €Pass 0 Fail-See the lmpairment.Section for details and corrective action taken. Device Type Code: . . . . Signal Type: EI Alarm,FtSupervisory Pathway: .Q Hardwired ❑Wireless/Fixed fl Wireless/Portable Device Area: 1 " / 1 <7:4. `=Floor:- / Location: /; Environment: ❑Indoor Outdoor Zone/Point#7--i94, r', f'I evice count on zone: . . of total devices on zone: -I Item/Model#: :' GF (z a--I Manufacturer: Action Taken(Checkall that apply):r Test EAdjust OClean ESensitivity Chec) Visual Functional❑Not Tested(Reason): ReSUIttE Pass El Fail—See the Impairment Section for details and corrective action taken. ©2012 Tyco Integrated Security. All rights reserved.(06/12) Page 3 of 5 Control.Panel 11 t c Page: of Pages: ..--- Inspection Job#: 111111 Integrated Security Fire Alarm/Burglar Alarm Devices Supplemental Page 8820UEOO Device Testing Detail Information(Enter Item/Model#and Manufacturer information if available.) . Device Type Code: /'C) . Signal Type: O.Alarm ❑ Supervisory Pathway:_,I:Hardwired ❑Wireless/Fixed ❑Wireless/Portable Alarm Type: ErStandard ❑ 24/7 ❑ N/A Device Group(BA/Hu only): Device Area: r� "�� " Floor: Location: _ Environment ❑lndoar ❑Outdoor Zone/Point#:#07c,/,/, - Device count on zone: of total devices on zone: Item/Model#: l r f- `''} Manufacturer: Action Taken(Check all that apply):,;nTest❑Adjust❑Clean❑Sensitivity Check 1yisuai3Functional Not Tested(Reason): • Result: { .-Pass ❑ Fail--See the Impairment Section for failure reasons and corrective action taken. Device Type Code: /.70-67.- 1 - Signal Type` ,,a._Alarm ❑ Supervisory Pathway:CI:Hardwired ❑Wireless/Fixed ❑Wireless/Portable Alarm Type: a:Standard ❑ 24/7 ❑ N/A Device Group(BA/Hu Only): Device Area: Pyr':�-, /1/2)-..,, ' ,,r - - zi,4-- i r?- Indoor ❑Outdoor Floor: r Location: z E Environment Zone/Point#: i 41 Al 4 EDD Vice count on zone: . of total devices on zone: Item/Model#: Manufacturer: _ Action Taken(Check all that apply):UTest❑Adjust❑clean❑SensitivityChecl' Visual.I Functional:Not Tested(Reason): Result:Q'"Pass .❑ Fail-See the Impairment Section for failure reasons and corrective action taken. • • Device Type Code: ,'1'fSupervisory Pathway; ❑Type: ❑Signal AlarnHardwired ❑ ess ❑ Wireless/Fixed Wireless/Portable gk.•S Alarm Type:;.0.standard ❑ 24/7 ❑N/A Device Group(BA/Hu Only): Device Area: :�:' C,Ali d if A'2..141 Floor: ,/:',-7.4e' Location: s,.:,r % -..,-/`-'' 0.7.- 't j Environments"[] indoor ❑ Outdoor Zone/Point#:fY r'd'r(:)ri Device count on zone: ,/ of total devices on zone: Item/Model#: Manufacturer: Action Taken(Check ail that apply): .,6-:fest['Adjust❑Clean['Sensitivity ChecCEIVisual Eitunctional❑Nat Tested(Reason): Result:u`Pass ❑.Fail-See the IinpairmentSection for failure reasons and corrective action taken. • Device Type Code: ' • Signal Type: ❑ Alarm❑ Supervisory Pathway: ❑Hardwired ❑Wireless/Fixed ❑Wireless/Portable • Alarm Type: ❑Standard ❑ 24/7 ❑N/A Device Group(BA/HU Only): • Device Area: ` Floor: Location: Environment: ❑Indoor ❑Outdoor Zone/Point#: Device count an zone:- of total devices on zone: . Item/Model#: • Manufacturer: Action Taken(Check all that apply): ❑Test❑Adjust❑Clean❑SensitivityCheck❑visuaI❑Functional❑Not Tested(Reason): . Result:❑ Pass ❑ Fail-See the Impairment Section for failure reasons and corrective action taken. "Device Type Code: -Signal Type: ❑ Alarm ❑ Supervisory Pathway: ❑ Hardwired ❑Wireless/Fixed ❑Wireless/Portable • Alarm Type: ❑ standard ❑ 24/7 ❑ N/A Device Group(BA/HU Only): Device Area: Floor: Location: Environment ❑ Indoor ❑Outdoor Zone/Point#.: . Device count on-zone: •of total devices on zone: Item/Model#: Manufacturer: Action Taken(Check all that apply): ❑Test❑Adjust❑Clean❑SensitivityCheck❑Visual❑Functional❑Nat Tested(Reason): • • " Result ❑ Pass ❑ Fail-See the Impairment Section for failure reasons and corrective action taken. ©2012 Tyco Integrated Security. All rights reserved.(06/12) Control Panel . Supplemental Page 3 of 5 Vico •..,-5 Integrated Security Page:....• of Pages: ` Inspection Job#: Fire Alarm/Burglar Alarm, Devices Supplemental PageI . 8820UE00 Device Testing Detail/nformation(Enter Item/Model#and Manufacturer information if available.) Device Type Code: Signal Type: ❑`Alarm ❑ Supervisory Pathway;;El-Hardwired ❑Wireless/Fixed ❑Wireless/Portable Alarm Typev,E,Standard ❑ 24/7 ❑N/A Device Group(BA/HU Only): • Device Area: r r `^ 14 /" ( Floor: 457— Location: 'E = r"c:r,. irc i Environment t _indoor ❑Outdoor Zone/Point#:/ / %c.:Z/ Device count on zone: of total devices on zone: Item/Model#: '— _ 5°T Manufacturer: /7 e ---.. f ° `-... Action Taken(Check all that apply);,❑Test Adjust EClean❑Sensitivity Check Visual['functional❑Not Tested(Reason): Result:F❑_Pass ❑ Fail-See the Impairment Section for failure reasons and corrective action taken. Device Type Code: i= Signal Type'_: Alarm ❑ Supervisory Pathway:4=1 Tlardwired ❑.Wireless/Fixed ❑Wireless/Portable Alarm Type:..E Standard ❑ 24/7 ❑N/A Device Group(BA/HU Only): Device Area: • Floor: ' 7 Location: , :f✓ /' rs✓r4L•`' ."-71r'Lt indoor Outdoor ,�;��- � � . � Environment,.,, ❑ Zone/Point#//,,Viii,760 ` .Device count on zone: ,../` of total devices on zone: r/ Item/Model#: Manufacturer: _p e:"5-.' f.•-`-',•:' Action Taken(Checkall thatepply):;0Test❑Adjust Clean❑sensitivity Check❑VisuaklFunctional['Not Tested(Reason): Result:'[ Pass .❑ Fail-See the.,,, impairment Section for failure reasons and corrective action taken. • Device Type Code: !""'• Signal Type:.17] Alarm ❑.Supervisory Pathway,:==50 Hardwired ❑wireless/Fixed ❑Wireless/Portable > Alarm Type:_. Standard -❑24/7 ❑ N/A Device Group(BA/HU Only): Device Area: - Floor: /5-1-- Location: ,,,e-7;-..!:-7- 4_, .f e-, i f<l it-i Environment ,..0 Indoor ❑Outdoor Zone/Point#:. 74Y //-10,5-Device count on zone: of of total devices on zone: ; `` Item/Model#: -i : . '�= .) Manufacturer: - •Action Taken(Check.all that appIy)/nTest❑Adjust❑Clean Sensitivity Checkl❑Visual,nFunctional❑Not Tested(Reason): Result:t®fi:,Pass ❑-Fail-See the Impairment Section for failure-reasons and corrective action taken. . Device Type Code: , .) . Signal Type ❑ Alarm ❑ Supervisory Pathway:;LI Hardwired ❑Wireless/Fixed ❑Wireless/Portable Alarm Type:FEFStandard ❑ 24/7 :❑N/A Device Group(BA/HU Only): Device Area: . %,., ❑fl"ndoor ❑Outdoor Floor: '; Location: _ .k �+ ' - Environment: " Zone/Point#: •/7:4//i Device count on zone: / of total devices on zone: / . Item/Model#: rt'l, `".._ <,> . Manufacturer: , 7 &# / X.-- Action - Action Taken(Check.all that apply) Test['Adjust['Clean❑Sen§itivity Check'❑Visual❑Functional❑Not Tested(Reason): • Result" •Pass- ❑ Fail-See the Impairment Section for failure reasons and.corrective action taken. ' Device Type Code: .IT z""" Signal.Type: 0...Aiarm D Supervisory Pathway:,_ 'Hardwired ❑Wirelest/Fixed '❑Wireless/Portable , Alarm Type: ,Standard ❑24/7 ❑N/A Device Group(BA/HU Only): Device Area: Floor: /5--7—. " , Location: a' ; i may' j,,e. , �, �.d-C. Environment ilar Indoor ❑Outdoor Zone/Poing ? e, Device count on zone: of total devices on zone: 7 Item/Model#: 11"• lam-7 : 'c7' Manufacturer: �"`-; ,. _./..,. `,4 • Action Taken(Check all-that apply): ❑Test❑Adjust❑Clean❑SensitivityChecJ`.VisuaJJ functional❑Not Tested(Reason): Result:`N Pass ❑ Fail-See the Impairment Section for failure reasons and corrective action taken. ©2012 Tyco Integrated Security. All rights reserved.(06/12) Control Panel Supplemental Page 3-of 5 1C111111 I Page: - of Pages: Inspection Job#:` -2} -7e Integrated Security Fire Alarm/Burglar Alarm Devices Supplemental Page 8820UE0O Device Testing Detail Information(Enter Item/Model#and Manufacturer information if available.) Device Type Code: < • Signal Type: 0 Alarm.° 'Supervisory Pathway:_:: Hardwired 0 Wireless/Fixed El Wireless/Portable Alarm Type: Standard ❑ 24/7 ❑ N/A Device Group(BA/HU Only): Device Area: ,,_ >s%, = `--t ,- °' / Floor: ./. 7 Location: ,r If j - A'I Environment j indoor III Outdoor Zone/Point#: /c/i0,•*-1C4 F. Device count on zone: / of total devices on zone: f, t Item/Model#: /-)--1,-, 4.2,w:. e)7 Manufacturer: `-- ; Action Taken(Check all that apply): 0Test❑Adjust DClean Sensitivity Check Visualaunctional❑Not Tested(Reason); Result: Pass ❑ Fail-Seethe Impairment Section for failure reasons and corrective action taken. Device Type Code: er -7 Signal Type: 0 Alarm..Supervisory PathWay:ErHardwired ❑Wireless/Fixed ❑Wireless/Portable Alarm Type: standard ❑ 24/7 ❑N/A Device Group(BA/HU Only): • e. Device Area: - : "f "' Floor: / °l Location: ,a- of-96 7 :5 ot";;t of";; i. .i.,:`, 4/,..- ria- , Environment. El-Indoor 0 Outdoor Zone/Point#e we ,//,---/.03:j Device count on zone: ../ .of total devices on zone: / Item/Model#: 7))dr-J-1/'=--: 1 t Manufacturer: f`": ,' Action Taken(Check all that apply):tnTest 0Adjust 0Clean Sensitivity CheckEVisualQFunctional❑Not Tested(Reason): Resu(t:,0'Pass D Fail-See the Impairment Section for failure reasons and corrective action taken. Device Type Code: • "-- Signal Type: 0 Alarrn1: '-supervisory Pathway::1 Hardwired E Wireless/Fixed 0 Wireless/Portable Alarm Type: Standard .Q 24/7 C N/A Device Group(BA/HU Only): • Device Area: Floor: /:c.7 Location: et ex--J ---' c'f/7i.-..-4.:.,,-_-_i—e-_,-,- ,-..}7,-;,-;:,,,---,,;:--.--*.Environment "indoor 0 Outdoor Zone/Point#: 7 ,/// 4 Device count on zone: of total devices on zone: 7 Item/Model#: J)79 f'.7.--•••• ..Sul Manufacturer: /-- A; Action Taken.(Checkall that apply): OTestElAdjust alean ElSensitivity Check JVisual,DFunctional LiNot.Tested(Reason): Result:,: '_Pass 0 Fail-Seethe Impairment Section for failure reasons and corrective action taken. Device Type Code: 77 ' Signal Type: 0 Alarm.;:Fti. Supervisory Pathway: . Hardwired 0 Wireless/Fixed ❑Wireless/Portable Alarm Type:=J-standard 0 24/7 0 N/A Device Group(BA/Hu Only):• Device Area: /-4;:.-`t A ,;�° t_ •„`mss Floor: ``?/ Location: ."-in-j.--i e . .4 ,. - £ re Fir-4•Environment: 111—indoor El Outdoor Zone/Point#f Shf% ' ' Device count on zone: .I . of total devices on zone: (er . Item/Model#: "11 I? A" _.-_-?<1/ _ Manufacturer: .- ' _-I-1 Action Taken(Check all that apply): ETest QAdjust OClean 0Sensitivity Check.LIVisual t�Functional-QNot Tested(Reason): • Result: Pass ❑ Fail-See the Impairment Section for failure reasons and corrective action taken. Device Type Code: A.------417r7.5 Signal Type: E Alarm 3 Supervisoy Pathway [E-.Hardwired El Wireless/Fixed El Wireless/Portable Alarm Type: .Q_Standard ❑ 24/7 Q N/A Device Group(BA/HU Only):_ Device Area: Floor: ° 5 i Location: �` ..�:f=,;�; i:-,-,,,,-.'r= -�--- Environment t "Indoor LI outdoor #: '� // I r 'ZQ i Zone/Point ce count on zone: / of total devices on zone: - . Item/Model#: rf* ' ,°r<{- -fit'r:; / Manufacturer: ` - -. £ — _ Action Taken(Check all that apply):„®Test DAdjust❑Clean OSensitivity Check,mVisual Functional LiNot Tested.(Reason): • Result "Pa"ss ❑ Fail—See the.lmpairment Section for failure reasons and corrective action taken. - 1201'2 Tyco Integrated Security. All rights reserved.(06/12) Control Panel • Supplemental Page 3 of 5 tycn - Inspection Job#: ?-51-119'44 II 011 111 Integrated Security Fire Alarm Inspection & Testing Report 881 SUED() Device Testing Summary Information Initiating Devices(Enter the total number alarm/supervisory devices and the number passed,failed or not tested and then the grand total of devices.) Total Device Type Alarm SupeTotal Passed Total Failed Total Not Tested Grand Total Manual Pull Station Ion Smoke Detector Photoelectric Smoke Detector • Duct Smoke Detector Smoke Beam Smoke Detector Fixed Temp Heat Detector Rate of Rise Heat Detector Waterflow Switch Tamper Switch(Gate Valve/PIV) Fire Pump POC • Sprinkler,High Low Pressure Generator POC POC(Other) Building Temperature,High Building Temperature,Low Water Temperature Water Level • Fire Pump Power Fire Pump Running Fire Pump Low Fuel I Indication Devices Device Type Total.Passed Total Failed Total Not Tested Grand Total Annunciator(FACP) Remote Annunciator Notification Devices Device Type • Total Passed Total Failed Total Not Tested Grand Total Bell Strobe Horn Strobe Speaker Strobe Speaker Chime 02012 Tyco Integrated Security. All rights reserved.(06/12) Page 4 of 5 Control Panel tgco. Inspection Job#: 7 S "/ 941 7C/ Ill li 11 II II III II 11 li Integrated Security , Fire Alarm Inspection & Testing Report 8818UE00 Back-up Battery Inventory(Enter the Item/Make number,Manufacturer,Mfg.Date,Install Date.Volts and Amp Hours for each back-up battery. Document whether the battery passed or failed and If the battery was replaced. Place a label on the replaced batteries with the date they are installed.) Item/Model# Manufacturer Mfg.Date Install Date Volts Ah Pass Feil Replaced Type _€f . may �,_!r ❑ ❑ ❑ - ! ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑. ❑ LI CI LI ❑ ❑ How many hours of back-up power are supplied by the batteries? ❑ 4-Hours ❑ 18-Hours ❑ 24-Hours ❑ 80-Hours Was a visual inspection of the batteries completed? ❑ Yes ❑ No _ l System Power Supplies i Device Type Total Passed Total Failed Total Not Tested Grand Total Primary Backup Remote"Notification Appliance Circuits"(NAC) Use the comments section to document any issues, discrepancies or equipment details not already documented on this form; include a list.of devices not tested and the reasons why. Comments: _. n - itl "' Date: n F Customer Name: ; s , Signature: , Print First and Last Name '; S 2. • Tyco Representative Name: : . .e, ,-rr -., Print First and Cast Name Tyco Representative ID#: •--;:'<:::4.. ;?' Fax all completed pages to the Inspection Management Team at (888) 497-2619 ©2012 TycoIntegrated Security. Ail rights reserved.(06/12) Page 5 of 5 Control Panel