Fire Alarm System - Annual/Quarterly Inspection and Testing Form

Fire Alarm System - Annual/Quarterly Inspection and Testing Form
Date
MonthDayYear
Time
Hour Minutes
AM/PM Option
Date of Last Inspection
MonthDayYear
Property Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
On-Site Contact
Phone Number
Format: (000) 000-0000.
Monitoring Company
Phone Number
Format: (000) 000-0000.
Monitoring Account Reference Number
Approving Agency
Phone Number
Format: (000) 000-0000.
Type Transmission
Other
Service
Other
Control Unit Manufacturer
Model Number
Circuit Styles
Number of Circuits
Software Rev.
Last Date System Had Any Service Performed
Last Date that Any Software/Configuration was Revised
Alarm-Initiating Devices and Circuit Information
Rows Quantity Circuit Style
Manual Fire Alarm Boxes
Photo Detectors
Ion Detectors
Duct Detectors
Heat Detectors
Waterflow Switches
Supervisory Switches
Other (Specify)
Alarm verification feature is
Alarm Notification Appliances and Circuit Information
Rows Quantity Circuit Style
Bells
Horns
Chimes
Strobes
Speakers
Other (Specify)
Number of Alarm notification appliance circuits
Are circuits monitored for integrity?

Supervisory Signal-Initiating Devices and Circuit Information

Rows	Quantity	Circuit Style
Building Temp.
Site Water Temp.
Site Water Level
Fire Pump Power
Fire Pump Running
Fire Pump Auto Position
Fire Pump or Pump Controller Trouble
Generator in Auto Position
Generator or Controller Trouble
Switch Transfer
Generator Engine Running
Other (Specify)

Signaling Line Circuits
Rows Quantity Style(s)
Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1)
System Power Supplies
Rows Nominal Voltage Amps
Primary (main):
System Power Supplies
Rows Type Amps
Overcurrent Protection
Location (of Primary Supply Panelboard)
Disconnecting Means Location
Batteries Last Installed
MonthDayYear
System Power Supplies
Rows Storage Battery Amp-Hr Rating
Secondary (standby)
System Power Supplies
Rows 24 60
Calculated capacity to operate system, in hours
Engine-driven generator dedicated to fire alarm system
Location of fuel storage
Battery Type
Other
Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply:
Prior to any Testing - Notification ares made
Rows Yes No Who Time
Monitoring Entity
Building Occupants
Building Management
Other (Specify)
AHJ Notified of any Impairments

Rows	Quantity	Style(s)
Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1)

Rows	Nominal Voltage	Amps
Primary (main):

Rows	Type	Amps
Overcurrent Protection

Rows	Storage Battery	Amp-Hr Rating
Secondary (standby)

Rows	24	60
Calculated capacity to operate system, in hours

Systems Tests and Inspections

Rows	Date	Time
15

Select theme:

Rows	Yes	No	Who	Time
Monitoring Entity
Building Occupants
Building Management
Other (Specify)
AHJ Notified of any Impairments

This testing was performed in accordance with applicable NFPA standards.