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Home My WebLink AboutFAI20-0020 010-250-006 CF FA 3-13-24 ALARM AND DETECTION REPORT Page 1 of 5 ..„ VOLTAGE\I%PECIALISTS 530-624-4514 610'fit6 Lic.nse 8660662 www.Voltag•Sp•cialists.com Inspection # 1-474 J ALARM & DETECTION EQUIPMENT TEST REPORT Type of Inspection: Annual Date: 3/13/24 Customer: Orchard Hospital Site: Main Street: 240 Spruce Street Contact: Mike Newton city/State: Gridley, CA. Phone#: 530-701-7687 Fax#: 1. Before Test Notify Proper Authorities: Name Phone # A. Owner or Owner's Rep Mike Newton 530-701-7687 B. Fire Department Gridley Fire 846-5678 C. Central Station Central Station Monitoring 1-800-722-0364 D. Central Station Acct# #40-3704 2. Control Panel Status Yes No Note # A. Is the system monitored by Central Station? X On Test Time: 8:00 Return to Service Time: 10:00 ".'4 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.18 Date Batteries Installed: 2021 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: 27.40 Battery Voltage without AC Power: 27.35 K. List any trouble conditions on panel before test: Note# Note# Comments: Note# Note# 3. FACP Manufacturer: Silent Knight Model# 5208 System Type: HARDWIRE Location of Annunciators: Location of Primary Power Source: Panel# Breaker Comments: Note# Note# Silent Knight Model# 5496 Panel/Breaker# Location:Roof Penthouse FCPS: Manufacturer: 9 P„4 Battery Voltage with A/C Power: 27.52 w/o A/C Power 27.50 Date: 8/17/23 FCPS: Manufacturer: Silent Knight Model# 5496 Panel/Breaker# Location:By FACP N/A Battery Voltage with NC Power: 27.45 w/o NC Power 27.12 Date: 6/22/23 FCPS: Manufacturer: Model# Panel/Breaker# Location: ‘,141.1I Battery Voltage with A/C Power: w/o A/C Power Date: Owner/Rep: Phone#: Date: Inspector Wyatt C. Phone#: 530-362-2609 Date:3/13/24 i Date:3/13/24 Inspector Sign: e - - Owners Rep Sign: ALARM AND DETECTION REPORT Page 2 of 5 Property Site: Main Operational • #Tested This Equipment Total# Report Yes N/A Note# 4. Remote Annunciators 5. Zones 6. Manual Stations (Pull) • Hardwire 10 10 X Addressable 7. Detectors Photoelectric 30 30 X Ionization Heats/Fixed or R of R Flame Duct (See#15) 8 8 X 8. Horn/Strobe Strobe Only 10 10 X Bell Speakers Horn Chime 9 9 X 9. Chime/Strobe 6 6 X 10. Automatic Door Release 9 9 X 11. Water Flow switches 1 1 X Did WIF Ring Outside Bell? Did WIF Activate Alarm Panel? 12. Tamper Switches 1 1 X 13. Ply OS&Y 14. 15. Did test of Duct Detectors shut down air handling units? X 16. Did the Monitoring Center(Fire Dept, Central Station, Lease Line)receive signal? X 17. Is system reset for normal conditions? X I 18. Is system restored to operational service? X I 19. Have Proper Authorities (see#1)been notified system is back in service? X List Proper Authorities:Gridley Fire,Central Station 20. Indicate%of equipment tested this report 25% 50% 75% ✓ 00% 21. Indicate%of equipment tested YTD 25% 50% 75% ✓ 00% Comments for any"no"answers or explanations (Note#): 3/13/24 Owners Rep Sign: _._ _. — Date: — — Inspector Sign: _T -. - ALARM AND DETECTION REPORT Page 3 of 5 Property Site: Main M Zone or DEVICE DEVICE SLC TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL DH ENTRANCE TO ICU X DH-9 DH DOUBLE DOORS TO 200 WING CORRIDOR X DH-7 DH DOUBLE DOORS TO 200 WING CORRIDOR X DH-8 DH DOOR TO ROTUNDA X DH-6 DH TREATMENT 5 X DH-5 DH REGISTRATION 1 X DH-2 is I DH REGISTRATION 2 X DH-3 DH RADIOLOGY CHECK IN X DH-1 DH BLOOW DRAW X DH-4 PDD FRONT ENTRANCE X 27 1 i. PDD ER WAITING FSD 4 X 27 2 PDD ER WAITING FSD 5 X 27 3 PDD OUTSIDE REGISTRATION FSD 3 X 28 1 PDD OUTSIDE REGISTRATION FSD 2 X 28 2 PDD OUTSIDE ADMINISTRATION FSD 1 X I 28 3 PDD PENTHOUSE X 23 1 is 1 PS ADMIN LOBBY X 7 1 PS OPERATION DIRECTOR'S OFFICE STORAGE X 8 124 PS FRONT LOBBY X 22 1 PS KITCHEN ALCOVE BY LOCKERS X 1 125 I PS BY FCPS X 4 13 PS CORRIDOR OUTSIDE ROOM 35 X 5 104 PS CORRIDOR OUTSIDE ROOM 25 X 10 108 PS CORRIDOR OUTSIDE ROOM 4 X 12 128 PS CORRIDOR OUTSIDE ROOM X-RAY X 13 120 ftilipo PS CORRIDOR OUTSIDE ROOM 45 X 14 1161 I 3/13/24 e- Owners -- _Rep Sign: _ — Date: ..— Inspector Sig„, _ _. • ALARM AND DETECTION REPORT Main Page 4 of 5 Zone or DEVICE am" DEVICE SLC n TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL PSD CORRIDOR TO DINING X , 2 126 } PSD CORRIDOR TO PHARMACY X I 2 127 PSD CORRIDOR OUTSIDE PHARMACY X 2 128 1, PSD CORRIDOR OUTSIDE ROOM 9 X 2 130 PSD CORRIDOR OUTSIDE RADIOLOGY X 3 119 PSD CORRIDOR OUTSIDE ER 1 X 3 121 1 PSD CORRIDOR OUTSIDE ER 3 X 3 122 . PSD CORRIDOR OUTSIDE ROOM 49 X 9 114 PSD CORRIDOR OUTSIDE ROOM 47 X 9 115 PSD CORRIDOR OUTSIDE SURGERY WORK ROOM X 9 117 PSD ICU CORRIDOR X 9 118 PSD CCU WAITING ALCOVE X 11 6 PSD CORRIDOR OUTSIDE ROOM 29 X 11 1 ' PSD CORRIDOR OUTSIDE ROOM 33 X 11 2 1 PSD CORRIDOR OUTSIDE ROOM 34 X 11 3 PSD CORRIDOR OUTSIDE ROOM 38 X 11 4 PSD CORRIDOR OUTSIDE ROOM 41 X 11 5 1 PSD ABOVE FACP X 15 1 PSD ELECTRICAL BY HR X 17 1 PSD FRONT LOBBY X 26 1 ' PSD ER WAITING X 26 2 PSD CORRIDOR OUTSIDE TRIAGE 1 X 26 3 PSD CORRIDOR OUTSIDE MEN'S RESTROOM @ BLOOD DRAW X 26 4 PSD CORRIDOR OUTSIDE ROOM 21A X 11 110 PSD MEDICAL SURGERY HALL X 11 111 PSD MEDICAL SURGERY HALL X 11 112 PSD CORRIDOR OUTSIDE ROOM 23A X 11 109 I PSD CORRIDOR OUTSIDE ROOM 25A X 11 107 1 PSD CORRIDOR OUTSIDE ROOF PENTHOUSE ABOVE FACP X 25 1 I PSD PENTHOUSE X 25 1 1 I r 3/13/24 Owners Rep Sign: Date: inspector Sign: _ _ - _ ALARM AND DETECTION REPORT Main Page 5 of 5 Zone or DEVICE DEVICE SLC # TYPE DEVICE LOCATION PASS FAIL NOTE it CHANNEL r KH ANSUL SYSTEM X 6 1 WF Water flow X 16 1 1 TS Tamper switch X 6 2 t 1 i 1 LEGEND PSD-Photoelectric Smoke Detector BD-BeamDetecto- H-Horn V-Visual ISD-Ionization Smoke Detector FS-Pull Station WPH-Weather P-oof Horn TS-Tamper Switch r 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-DoorHcader DHS-DoorHolder&SmokeDetectx FD-Flame Detector S-Speaker 0SY-Outside Stem&Yoke TarrperValve SSD-Sianal Station Smoke Detector R-Rpll AV-Audible Visual PR/-Post Innicat_or Valve Cur-Elevator Curtains FRD-Fire Rolldown Door SDC Smoke Detector&Door Holder Combo CO-Carbon Monoxide Detector - _ -- NOTE# I COMMENT viumw 3/13/24 e- - - - __ —. _ Inspector Sign: — Owners Rep Sign: Date: Page 1 of 2 x rrrr VOLTAG VOLTAGE4SPECIALisTs 530-624-4514 Cto1C16 License N880862 www.VoltagoSpercialis ts.corn Inspection # F SENSITIVITY INSPECTION Type of Inspection: i-e.Quarterly,Annual Sensitivity Date: 4/15/2024 Property Name: Orchard Hospital Street: 240 Spruce st Contact: Mike Newton City& State: Gridley Ca Phone: 530-701-7687 • Voltsf Device Device#I Make/Model: I Location: I Sensitivity I Pass + Fail I Notes: PSD zN11-1 System sensor 2WTA-B I Hallway at nurse station I I 2.6 I X PSD zN11-2 System sensor2wTA-B I Hallway outside room 33 ' 2.4 j X PSD zN11-3 System sensor2WTA-B I Hallway at room 348 2.4 I X PSD zN11-4 System sensor 2WTA-B I Hallway at room 38 I X 2 PSD zN11-5 System sensor2WTA-B I Hallway at room 41 2.6 X PSD FPS 107 System sensor 2WTA-B I Hallway at room 25B I i 2.4 X PSD FPS109 System sensor 2WTA-6 I Hallway at room 23B I J 2.4 X PSD FPS 110 System sensor 2WTA-B I Hallway at room 21 A double doors 2.4 X V PSD FPS 111 System sensor 2WTA-B I Hallway at room south side of double doorIs f 2.4 X PSD FPS 112 System sensor 2WTA-B I Hallway at rotunda to rooms 21-28 X I 2 PSD FPS 127 System sensor 2WTA-8 I Hallway at rotunda to rooms 4-9 i 2.6 X PSD FPS 128 System sensor 2WTA-B+ Hallway at Pharmacy i 2.6 X PSD FPS 130 System sensor 2wTA-B I Hallway at room 9A 2.4 X PSD FPS118 System sensor2WTA-B I Hallway at rotunda to rooms 45-51 I X 2 PSD FPS 11-11 System sensor 2WB I Alcove j 2.4 X PSD FPS 117 System sensor2WTA•B I Hallway at room 45 ` 2.4 X PSD FPS 115 System sensor 2WTA-B I Hallway at room 47 2.4 X 2 PSD FPS 114 System sensor 2WTA-B I Hallway at room 49 i 2.6 X 2 PSD FPS 122 System sensor 2WTA-B I Hallway at rotunda treatment room 3 i 2.6 X PSD FPS 121 System sensor 2WTA-B I Hallway at Xray. i 2.6 X PSD FPS 119 System sensor 2wTA.B j Hallway X Ray waiting I 2.4 X PSD FPS 126 System sensor 2WB I Hallway at rotunda to dinning I 2.2 X PSD ZN 26-3 System sensor 2W8 I Hallway to front lobby 2.6 X • PSD ZN 26-4 System sensor 2WB 1 Lobby restroom hallway I 2.6 X PSD ZN26-2 System sensor 2W6 I Front Lobby I 2.4 X PSD ZN26-1 System sensor 2WB I Front lobby foyer I 2.6 X PSD ZN25-1 System sensor 2WB I Penthouse ` 2.6 X PDD ZN23-1 System sensor D4120 I Penthouse N/A X 1 PDD ZN23-2 System sensor D4120 I Penthouse i N/A X 1 PSD ZN17 System sensor 2WB I Switch room I 2.6 X (j( CUSTOMER SIGNATURE DATE: 4/15/2024 VOLTA E H SI NATURE: Page 2 Of 2 Volts/ Device Device#I Make/Model: I Location: I Sensitivity I Pass I Fail I Notes: PSD I 132 System sensor 2wta I Room 6 ER I I 2.4 X I PSD I Zn-1 System sensor 2wta J Above FACP I I 2.6 X I PDD I 27-1 System sensor D41201 Front entrance I X 1 PDD I 27-2 System sensor D4120 I ER waiting 4 1 X 1 PDD I 27-3 System sensor D4120 I ER waiting 5 I X 1 PDD I 28-1 System sensor D4120I Outside registration i X 1 PDD 28-2 System sensor 041201 Outside registration I J X 1 PDD I 28-3 System sensor 041201 Outside admitting I X 1 I I I I I I I1 I I I I 1 I II i I I li I I II I I i ! I I I Nor I I I '. I I I I I I I 1 I I I I I I i i NOTES #1 system sensor use flashes on duct detectors to determine sensitivity. Passed per manufactures spec. #2 out of calibration failed System sensor 2WB 1.0 to 4.0, System sensor 2WTA-B 1.0 to 3.62 CUSTOMER SIGNATURE DATE: 4/15/2024 VOLTA H R . .