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Home My WebLink AboutFAI22-0006 010-250-025 CF FA Hovlid Community Care 10.25.21 ALARM AND DETECTION REPORT Page 1 of 7 VOLTAG PECIALisTs 530-624-4514 C101C16 License#880862 www.VoltageSpecialists.com Inspection # 1-596 ALARM & DETECTION EQUIPMENT TEST REPORT Type of Inspection: Annual Date: 10/25/21 Customer: Orchard Hospital Site: HOVLID COMMUNITY CARE Street: 246 Spruce contact: Bill Lagrone City/State: Gridley, CA Phone#: 530-456-0400 Fax#: 1. Before Test Notify Proper Authorities: Name Phone # A. Owner or Owner's Rep Mike Newton 530-707-7687 B. Fire Department Gridley FD 530 846-5711 C. Central Station Central Station 1-800-722-0364 D. Central Station Acct# 40-3713 2. Control Panel Status Yes No Note # A. Is the system monitored by Central Station? X On Test Time: 09:30 Return to Service Time: 15:00 B. Is the Power Light on? X C. Does the Panel indicate Normal conditions? X D. Are all indicating Lamp Bulbs in Operator order? X E. Does the Trouble Light operate? X F. Does the Silence Switch Operate? X G. Battery A.H.50 Date Batteries Installed: 1/15/18 H. Does the Panel have Non-Operational Zones? X I. Does the Panel have Battery Backup? X J. Do the batteries indicate they are Properly Charged? X Condition of Batteries: Good Note# Battery Voltage with AC Power: 26.70 Battery Voltage without AC Power: 26.16 K. List any trouble conditions on panel before test: Note# Note# Comments: Note# Note# 3. FACP Manufacturer: GE Model# EST 3 System Type: ADDRESSABLE Location of Annunciators: Lobby Location of Primary Power Source: Panel# Breaker Comments: Note# Note# FCPS: Manufacturer: Wheelock R Model# PS-8 Panel/Breaker# Location:fAt6ieRibebping Battery Voltage with A/C Power: 27.31 w/o A/C Power 2728 Date: 1/15/18 FCPS: Manufacturer: Wheelock L Model# PS-8 Panel/Breaker# Location:Housekeeping Battery Voltage with A/C Power: 27.35 w/o A/C Power 27.27 Date: 1/15/18 FCPS: Manufacturer: Model# Panel/Breaker# Location: Battery Voltage with A/C Power: w/o A/C Power Date: Owner/Rep: Phone#: Date: Inspector: Randy Rader Phone#: 530-362-2609 Date: 10/25/21 Owners Rep Sign: Date:10/25/21 Inspector Sign: 00)- ALARM AND DETECTION REPORT Page 2 of 7 Property Site: HOVLID COMMUNITY CARE Operational #Tested This Equipment Total# Report Yes N/A Note# 4. Remote Annunciators 1 1 X 5. Zones 6. Manual Stations (Pull) Hardwire Addressable 10 10 X 7. Detectors Photoelectric 93 93 X Ionization Heats/Fixed or R of R 16 16 X Flame Duct(See#15) 2 2 X 8. Horn/Strobe Strobe Only 14 14 X Bell 1 1 X 1 Speakers Horn Chime/Strobe 22 22 X 9. 10. Automatic Door Release 58 58 X 11. Water Flow switches 1 1 X Did W/F Ring Outside Bell? Did W/F Activate Alarm Panel? 12. Tamper Switches 1 1 X 13. PIV OS &Y 14. 15. Did test of Duct Detectors shut down air handling units? 16. Did the Monitoring Center(Fire Dept, Central Station, Lease Line) receive signal? X 17. Is system reset for normal conditions? X 18. Is system restored to operational service? X 19. Have Proper Authorities (see#1)been notified system is back in service? X List Proper Authorities:Central station, FD 20. Indicate %of equipment tested this report 25% 50% 75% if 100% 21. Indicate %of equipment tested YTD 25% 50% 75% if 100% Comments for any"no"answers or explanations (Note#): 10/25/21 11- Owners Rep Sign: Date: Inspector Sign: ALARM AND DETECTION REPORT Page a of Property Site: HOVLID COMMUNITY CARE DEVICE zone or SLC DEVICE # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL HT SHOWER CORR 200 XX 134 HT CENTRAL SUPPLY CORR 400 XX 135 HT SHOWER CORR 300 XX 136 HT SHOWER HALLWAY 300 XX 145 HT SCULLERY XX 284 HT KITCHEN XX 285 HT KITCHEN X 286 HT STORAGE (OUTSIDE) X 287 HT WATER STORAGE (OUTSIDE) X 288 HT MEN'S RR BY BREAKROOM X 289 HT WATER HEATER X 290 HT WOMEN'S RR BY BREAKROOM X 291 HT CONFERENCE ROOM CLOSET X 292 HT WEST UNISEX RR X 293 HT EAST UNISEX RR X 294 HT JANITOR'S CLOSET IN KITCHEN X 295 PDD AC-1 ON ROOF X 142 PDD AC-2 ON ROOF X 387 PS CORRIDOR 200 X 126 PS CORRIDOR 300 X 127 PS CORRIDOR 400 X 128 PS NURSE STATION X 129 PS RECREATION ROOM X 376 PS MAINTENANCE OFFICE X 377 Owners Rep Sign: Date: 10/25/21 inspector Sign: aft ALARM AND DETECTION REPORT HOVLID COMMUNITY CARE Page 4 of 7 DEVICE zone or SLC DEVICE # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL PS SERVICE CORRIDOR X 378 PS KITCHEN EXIT X 379 PS LOBBY X 380 PS LAUNDRY EXIT X 388 PSD HOUSEKEEPING X 001 PSD OXYGEN STORAGE X 002 PSD MED ROOM X 003 PSD NURSE CORRIDOR X 004 PSD CORRIDOR 200 ROOM 202 X 005 PSD CORRIDOR 200 ROOM 212 X 006 PSD CORRIDOR 200 ROOM 210 X 007 PSD CORRIDOR 200 ROOM 208 X 008 PSD CLEAN UTILITY X 009 PSD STAFF DEVELOPMENT X 010 PSD 2 BED ROOM 201 X 011 PSD 2 BED ROOM 202 X 012 PSD 2 BED ROOM 203 X 013 PSD 2 BED ROOM 204 X 014 PSD 2 BED ROOM 205 X 015 PSD 2 BED ROOM 206 X 016 PSD 2 BED ROOM 207 1 X 017 PSD 2 BED ROOM 214 X 018 PSD 2 BED ROOM 212 X 019 PSD 2 BED ROOM 211 X 020 PSD 2 BED ROOM 210 X 021 PSD 2 BED ROOM 209 X 022 PSD 2 BED ROOM 208 X 023 PSD CORRIDOR 300 ROOM 312 X 024 PSD CORRIDOR 300 ROOM 311 X 025 PSD CORRIDOR 300 ROOM 309 X 026 Owners Rep Sign: Date: 10/25/21 Inspector Sign: aa ALARM AND DETECTION REPORT HOVLID COMMUNITY CARE Page 5 of 7 DEVICE zone or SLC DEVICE # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL PSD CORRIDOR 300 ROOM 306 X 027 PSD 2 BED ROOM 312 X 028 PSD 2 BED ROOM 311 X 029 PSD 2 BED ROOM 310 X 030 PSD 2 BED ROOM 309 X 031 PSD 2 BED ROOM 308 X 032 PSD 2 BED ROOM 307 X 033 PSD 2 BED ROOM 301 X 034 PSD 2 BED ROOM 302 X 035 PSD 2 BED ROOM 303 X 036 PSD 2 BED ROOM 304 X 037 PSD 2 BED ROOM 305 X 038 PSD 2 BED ROOM 306 X 039 PSD CORRIDOR 400 SOIL UTL X 040 PSD CORRIDOR 400 ROOM 401 X 041 PSD CORRIDOR 400 ROOM 410 X 042 PSD CORRIDOR 400 ROOM 408 X 043 PSD STORAGE CORR 400 X 044 PSD CLOSET CORR 400 X 045 PSD BEDROOM 411 X 046 PSD 2 BED ROOM 410 X 047 PSD 2 BED ROOM 409 X 048 PSD 2 BED ROOM 408 X 049 PSD 2 BED ROOM 407 X 050 PSD 2 BED ROOM 406 X 051 PSD 2 BED ROOM 405 X 052 PSD 2 BED ROOM 404 X 053 PSD 2 BED ROOM 403 X 054 PSD 2 BED ROOM 402 X 055 PSD 2 BED ROOM 401 X 056 PSD 2 BED ROOM 105 X 057 PSD SOILED UTILITY X 058 PSD BEDROOM 314 X 059 G�c 10/25/21. aa Owners Rep Sign: Date: Inspector Sign: ALARM AND DETECTION REPORT HOVLID COMMUNITY CARE Page 6 of DEVICE Zone or DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL # PSD DIRECTOR OF NURSING X 251 PSD CORRIDOR 100 ROOM 102 X 252 PSD CORRIDOR 100 ROOM 104 X 253 PSD CORRIDOR BY HR X 254 PSD LOBBY X 255 PSD SERVICE CORR BY LAUNDRY X 256 PSD SERV CORR BY GEN STORE X 257 PSD 2 BED ROOM 103 X 258 PSD 2 BED ROOM 104 X 259 PSD 2 BED ROOM 102 X 260 PSD 2 BED ROOM 101 X 261 PSD BARBER SHOP X 262 PSD THERAPY/GYM OFFICE X 263 PSD REC ROOM CLOSET X 264 PSD EXECUTIVE DIRECTOR X 265 PSD ADMISSIONS X 266 PSD LOBBY X 267 PSD DINNING X 268 PSD DINNING X 269 PSD DINNING X 270 PSD DIETICIAN X 271 PSD DRY STORAGE X 272 PSD SOCIAL SERV/MED'S X 273 PSD RESIDENT LOUNGE 1 X 274 PSD RECEPTIONIST X 275 PSD EMPLOYEE LOUNGE X 276 PSD EMPLOYEE LOUNGE X 277 PSD JANITOR STORAGE X 278 PSD CLEAN ROOM X 279 PSD SOILED LINEN X 280 PSD LAUNDRY X 281 PSD BUSINESS OFFICE MED RECORD'S _ X 282 PSD MAINTENANCE OFFICE X 7L83 Owners Rep Sign: Date: 10/25/21 Inspector Sign: ALARM AND DETECTION REPORT HOVLID COMMUNITY CARE Page 7 of 7 Zone or DEVICE DEVICE SLC # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL WF SPRINKLER RISER X 381 TS SPRINKLER RISER X 382 LEGEND PSD—Photoelectric Smoke Detector BD—Beam Detector H—Horn V—Visual ISD—Ionization Smoke Detector PS—Pull Station WPH—Weather Proof Horn TS—Tamper Switch PDD—Photo Duct Smoke Detector RR—Rate of Rise Heat Detector C—Chime WF—Water Flow Switch IDD—Ion Duct Smoke Detector HT—Fixed Temp Heat Detector CV—Chime Visual DH—Door Holder DHS—Door Holder&Smoke Detector FD—Flame Detector S—Speaker OSY—Outside Stem&Yoke Tamper Valve SSD—SignalStationSmokeDetector B—Bell AV—Audible Visual PIV—Post Indicator Valve Cur-Elevator Curtains FRD-Fire Rolldown Door SDC Smoke Detector&Door Holder Combo CO-Carbon Monoxide Detector - - - NOTE # COMMENT 10/25/21 ` Owners Rep Sign: Date: Inspector Sign: 0 �