Fire Alarm System - Annual/Quarterly Inspection and Testing Form
Date*
Month Day Year
Time*
: Hour Minutes AM/PM Option
Date of Last Inspection*
Month Day Year
Service Company: Hawkeye Electric
1710 Hawkeye Drive, Hiawatha, IA 52233 | 319-743-9891
Property Name*
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
On-Site Contact*
Phone Number*
Area Code Phone Number
Monitoring Company*
Phone Number
Area Code Phone Number
Monitoring Account Reference Number*
Approving Agency
Phone Number
Area Code Phone Number
Type Transmission
McCulloh Multiplex Digital Reverse Priority RF
Service
Weekly Monthly Quarterly Semiannually Annually
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?
Yes No

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*
Month Day Year
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 Cell Nickel-Cadmium Seal Lead-Acid Lead-Acid
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 700 Legally required standby described in NFPA 70, Article 701 Optional 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

Initiating and Supervisory Device Tests and Inspections
Location and S/N Device Type Visual Check Functional Test Factory Setting Measured Setting Pass Fail
Comments
Emergency Communications Equipment
Visual Functional Comments
Phone Set
Phone Jacks
Off-hook Indicator
Amplifier (s)
Tone Generator (s)
Call-In Signal
System Performance
Interface Equipment and Special Hazard Systems
Specify Type Visual Device Operation Simulated Operation
Special Procedures:
Comments:
Supervising Station Monitoring and Notifications that Testing is Complete
Yes No Time Comments/Who
Alarm Signal
Alarm Restoration
Trouble Signal
Supervisory Signal
Supervisory Restoration
Building Management
Monitoring Agency
Building Occupants
Other
The following did not operate correctly:
System Restored to Normal Operation
Date Time
This testing was performed in accordance with applicable NFPA standards.
Name of Inspector*
Date*
Month Day Year
Inspector must Initial for electronic signgature*
Name of Property Contact*
Date*
Month Day Year
Owner must Initial for electronic signgature*
Should be Empty:

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

Fire Alarm System - Annual/Quarterly Inspection and Testing Form

Service Company: Hawkeye Electric