Fire Inspection Form Step 1 of 10 10% Inspection Status(Required) Pass Fail Ref S/O(Required) NFPA Fire Alarm Inspection FormDate(Required) Time(Required) Hours : Minutes AM PM AM/PM Service OrganizationInspector(Required) License #(Required) Nicet #(Required) Property Name(Required)Monitoring EntityAccount #(Required) Rapid Response Monitoring: 400 W Division St. Syracuse NY 13204? Yes Other Approving Agency(Required)Type TransmissionType(Required) IP Cell POTS Frequency(Required) Monthly Semi-Annual Annual Other Other IP(Required) MEID(Required) POTS 1(Required) POTS 2(Required) Panel Manufacturer & Type(Required) Circuit Styles(Required) # Circuits(Required) Software Revision(Required) Last Service(Required) Last Software OR Configuration Date(Required) Other Prior To Any TestingNotifications Are MadeMonitoring Company(Required) Yes No Who(Required) Time(Required) Hours : Minutes AM PM AM/PM Building Management(Required) Yes No Who(Required) Time(Required) Hours : Minutes AM PM AM/PM TypeControl panel(Required) Visual Functional Lamps/LED's(Required) Visual Functional Fuses(Required) Visual Functional Primary power supply(Required) Visual Functional Trouble signals(Required) Visual Functional Disconnect switches(Required) Visual Functional Ground fault monitoring(Required) Visual Functional CommentsTransient SuppressorsInterface EquipmentSpecify Interface Equipment #1(Required) Interface Equipment #1(Required) Visual Functional Simulated Operation N/A Specify Interface Equipment #2(Required) Interface Equipment #2(Required) Visual Functional Simulated Operation N/A Specify Interface Equipment #3(Required) Interface Equipment #3(Required) Visual Functional Simulated Operation N/A Special Hazard SystemsSpecify Special Hazard System #1(Required) Special Hazard System #1(Required) Visual Functional Simulated Operation N/A Alarm(Required) Alarm(Required) Visual Functional Simulated Operation N/A Trouble(Required) Trouble(Required) Visual Functional Simulated Operation N/A Supervisory(Required) Supervisory(Required) Visual Functional Simulated Operation N/A System FunctionalityAlarm System Test Results Acceptable?Trouble signal with AC power off?(Required) Yes No NA System operates properly on battery backup?(Required) Yes No NA All signals operate on AC power?(Required) Yes No NA Type Battery(Required)TypeAHStartingLoadChargeQTYDate Add Remove System Functionality: Part 2Means of Disconnect(Required) Breaker Fuse Panels(Required)PanelTypeLocationVoltAmpsPanelIDNumber of Initiating CircuitsNumber of Signal Circuits Add RemoveDoes alarm system meet audibility standards?(Required) Yes No NA All circuits checked for electrical supervision?(Required) Yes No NA All auxiliary equipment operates (elevators, fans, dampers)?(Required) Yes No NA Ventilation controls operate?(Required) Yes No NA Key to panel available?(Required) Yes No NA Operating instructions at panel?(Required) Yes No NA Pull station restore tools at main panel (rods, keys, etc.)?(Required) Yes No NA Trouble indicators function properly?(Required) Yes No NA Remote annunciator panels function properly(Required) Yes No NA Elevator Call Down Functions Properly Elevators(Required)NameFunctions Properly? (Yes, No, N/A)FloorsNumber of Stories Add Remove Test record posted at panel?(Required) Yes No NA Was a full walkthrough done?(Required) Yes No NA System left in service?(Required) Yes No NA Informed owner of inspection and testing results & all system deficiencies?(Required) Yes No NA Do all powered locking devices release upon activation of the fire alarm systems?(Required) Yes No NA Do all powered locking devices release upon power failure of the fire alarm systems?(Required) Yes No NA Do all fire doors release and latch?(Required) Yes No NA Do fire doors unlock but not unlatch?(Required) Yes No NA System Functionality: Part 3System DevicesRequired to list devices?(Required)YesNoElectric Strike Test Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveElectric BoltTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveOther Locking DevicesTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveBells, Horns, ChimesTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveHorn Strobes (stand alone)Test Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveStrobes OnlyTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveVoice Speakers (voice clarity)Test Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveSmoke DetectorsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveHeat DetectorsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveDuct DetectorsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveHAVC ShutdownTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveSprinkler Flow SwitchesTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveSprinkler Supervisory SwitchesTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveDoor HoldersTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveDoor ReleaseTest Results Acceptable(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveManual Pull StationsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveAutomatic Door UnlocksTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveAutomatic Door ReleaseTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveAnnunciatorsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveBeam DetectorsTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveFire/Smoke DampersTest Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add RemoveKitchen Hood / Suppression Test Results Acceptable?(Required) Yes No NA Total Devices(Required)Total Tested(Required)List Devices (If Required)TypeLocationIDTested?Pass/FailNote Add Remove Communication EquipmentOn/Off Premises MonitoringAlarm Signal(Required) Yes No Alarm Signal Start(Required) Hours : Minutes AM PM AM/PM Alarm Signal End(Required) Hours : Minutes AM PM AM/PM Alarm Restoral(Required) Yes No Alarm Restoral Start(Required) Hours : Minutes AM PM AM/PM Alarm Restoral End(Required) Hours : Minutes AM PM AM/PM Trouble Signal(Required) Yes No Trouble Signal Start(Required) Hours : Minutes AM PM AM/PM Trouble Signal End(Required) Hours : Minutes AM PM AM/PM Supervisory Signal(Required) Yes No Supervisory Signal Start(Required) Hours : Minutes AM PM AM/PM Supervisory Signal End(Required) Hours : Minutes AM PM AM/PM Supervisory Restoral(Required) Yes No Supervisory Restoral Start(Required) Hours : Minutes AM PM AM/PM Supervisory Restoral End(Required) Hours : Minutes AM PM AM/PM DID ALL POINTS REPORT?(Required) Yes No NA DID YOU SIGN THE ELEVATIOR INSPECTION BOOK?(Required) Yes No Comments Deficiency / Correction DetailsAny Deficiencies Found(Required) Yes No Any Deficiencies Remaining(Required) Yes No List DeficienciesDeficiencyCommentRepairedDateBy Add RemoveAdd Review Notes?(Required) Yes No Review Notes(Required)Add Special Instructions?(Required) Yes No Special Instructions(Required)Picture Of The Main Fire Alarm Panel(Required) Drop files here or Select files Max. file size: 256 MB. Inspector's Declaration This testing was performed in accordance with applicable NFPA standards. I certify, under penalty of perjury, that I am a valid agent of Fisher Systems, Inc., representing that the Fisher Systems, Inc., maintains all the necessary licenses and/or certifications to perform this service for this system in this jurisdiction AND THAT Fisher Systems, Inc., has properly inspected this system consistent with state and local standards AND THAT the system has been properly tagged or labeled and the property owner or responsible person has been notified of the inspection results, the system status, and any corrective actions. Other CommentsSignature of Inspector(Required)Name of Owner/Rep(Required) First Last Signature of Owner/Rep(Required) Email To Send Inspection Form To(Required) Δ
