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*
Monitoring Company*
Phone Number
Monitoring Account Reference Number*
Approving Agency
Phone Number
Type Transmission
McCullohMultiplexDigitalReverse PriorityRFOther
Service
WeeklyMonthlyQuarterlySemiannuallyAnnuallyOther
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
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
Quantity Circuit Style
Bells
Horns
Chimes
Strobes
Speakers
Other (Specify)
Number of Alarm notification appliance circuits
Are circuits monitored for integrity?
YesNo

Supervisory Signal-Initiating Devices and Circuit Information

	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
Quantity Style(s)
Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1)
System Power Supplies
Nominal Voltage Amps
Primary (main):
System Power Supplies
Type Amps
Overcurrent Protection
Location (of Primary Supply Panelboard)
Disconnecting Means Location
Batteries Last Installed*
MonthDayYear
System Power Supplies
Storage Battery Amp-Hr Rating
Secondary (standby)
System Power Supplies
24 60
Calculated capacity to operate system, in hours
Engine-driven generator dedicated to fire alarm system
Location of fuel storage
Battery Type
Dry CellNickel-CadmiumSeal Lead-AcidLead-AcidOther
Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply:
Emergency System described in NFPA 70, Article 700Legally required standby described in NFPA 70, Article 701Optional standby system described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701
Prior to any Testing - Notification ares made
Yes No Who Time
Monitoring Entity
Building Occupants
Building Management
Other (Specify)
AHJ Notified of any Impairments

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

	Nominal Voltage	Amps
Primary (main):

	Type	Amps
Overcurrent Protection

	Storage Battery	Amp-Hr Rating
Secondary (standby)

	24	60
Calculated capacity to operate system, in hours

Systems Tests and Inspections

	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.