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Report �PS Z CP 1 Zvac'$i 72 - NATIONAL FIRE ALARM AND SIGNALING CODE INSPECTION, TESTING, AND MAINTENANCE 72 - FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM 3. TYPE OF SYSTEM OR SERVICE (continued) To be completed by the system inspector or tester at the time of the inspection or test. NFPA 72 edition: Additional description of system(s): I It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necesry to provide a complete record. 3.1 Control Unit tt� g Manufacturer: S I L�T K � I 4 f► / Model number: 45).0 2 11 2 Time o ins ection o test: I - �0 Ff Date of this inspection or test: p 3.2 Mass Notification System X This system does not incorporate an MNS. 1. PROPERTY INFORMATION / f ��++ 3.2.1 System Type: ::: property: jo D NEI 11Ao l— C I (I 30 7 j ( 42- ' 4 go TI Ggtz.n o R 0 In- building MNS — st o Wide -area MNS 0 Distributed recipient MNS I Description of property: 1101(51N CI 5kt;LTC>Q- 0 Other (specify): I Occupancy type: 2%StOGr►T1 kL- r1 .1� V 3.2.2 System Features: Name of property representative: -� . 5c O Combination fire ala . I . O ACU only 0 Wide -area MNS to regional national alerting interface {��� ;14 UP Pho 3 I 1 I 3 a Sw 17�+1�, � �- �OSCy Fax: E-mail: 0 Local operating console ( I t Ii I / t recipient MNS (DRMNS) 0 Wide -area MNS to DRMNS interface Phone: : �3 0 Wide -area MNS to high -po a =pe :. • r . ay (HPSA) interface 0 In- building MNS to wide -area MNS interface Authority having jurisdiction over this property: Ti (4g-0 3 r, t � . ,�M 0 Other (specify): Phone: }� Fax: E -mail: 3.3 System Documentation 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION were U An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the Service and/or testing organization for this equipment: i4N I 7-5 i 1Q -6 record drawings are stored on site. Location: Address: 4 M14 3 €0i.V0 PtiR-fi,h4 a - 77 21 1 3.4 System Software ❑ This system does not have alterable site - specific software. Phone: S `7-19 - 077 1 Fax: co 3- 2y.9 -0 S1'L- E -mail: 36E-- Software revision num . / 36E-- nn�� Software last updated on: � Service technician or tester: 1 �' ❑ A copy of the site -spe • is so i . . is stored on site. Location: . Qualifications of technician or tester: . A contract for test and inspection in accordance with NFPA standards is in effect as of: 4. SYSTEM POWER The contract expires: Contract number: Frequency of tests and inspections: c^� 4.1 Control Unit Monitoring organization for this equipment: co N i rAd L- 4.1.1 Primary Power Address: j Phone: 57) 'S '-'7,-1.3 7125 Fax: E - mail: Input voltage of control panel: j 2Z . 3 Control panel amps: Entity to which alarms are retransmitted: Sit. 1 7124) L Phone: Sb? -21.3 --)22.1 4.1.2 Engine -Drive enerator This system does not have a generator. Location of genera r r� 3. TYPE OF SYSTEM OR SERVICE Location of fuels age: Type of fuel: Fire alarm system (nonvoice) 4.1.3 Uninterruptible o er System ❑ This system does not have a UPS. ❑ Fire alarm with in- building fire emergency voice alarm communication system ( EVACS) , Equipment powere by U S s m: 1 ❑ Mass notification system (MNS) Location of UPS s m ❑ Combination system, with the following components: Calculated capaci batte 'es to drive the system components connected to it: ❑ Fire alarm 0 EVACS ❑ MNS 0 Two -way, in- building, emergency communication system In standby mode (hours): In alarm mode (minutes): 0 Other (specify): C 2009 National Fire Protection Association NFPA 72 (p. 1 of 11) 0 2009 National Fire Protection Association NFPA 72 (p. 2 of 11) f' FIGURE 14.6.2.4 Example of an Inspection and Testing Form. FIGURE 14.6.2.4 Continued • f t 2010 Edition I, 2010 Edition (' — - INSPECTION, TESTING, AND MAINTENANCE 72-81 72-80 NATIONAL FIRE ALARM AND SIGNALING CODE 4. SYSTEM POWER (continued) 4. SYSTEM POWER (continued) 4.3.4 Batteries 4.1.4 Batteries Nominal voltage: Amp/hour rating: ZY 6 G our rating: 7A-If Location: 'type: g p g: Location: ® Type: 1�� Nominal voltage: � P� g Calculated c: I; y • . , t' -ries to drive the system: Calculated capacity of batteries to drive the system: I C y I 1 In standby m e (ho s): In alarm mode (minutes): In standby mode (hours): Z 1 ft-00-5 In alarm mode (minutes): - ❑ Batteries are marked with date of manufacture. Batteries are marked with date of manufacture. 4.2 In Building Fire Emergency Voice Alarm Communication System or Mass Notification System 5. ANNUNCIATORS ❑ This system does not have annunciators. ❑This system Q does not ve n EVACS or MNS. 5.1 Location and Description of Annunciators iJ Annunciator 1: A r i�� N f to ' 6 r 4.2.1 Primary Po r Annunciator 2: Input voltage of EV r N anel: EVACS or MNS panel amps: Annunciator 3: ! 4.2.2 Engine -Driven Gen rator ❑ This system does not have a generator. Location of generator: 6. NOTIFICATIONS MADE PRIOR TO TESTING Location of fuel storage: Type of fuel: Monitoring organizatio Contact: .5 ( ? C1 L Time: , ,uv 4.2.3 Uninterruptibl Power System ❑ This system does not have a UPS. Building manage ent Contact: Tritit Time: ��. Building occupan Contact: Time: V Equipment powe b a system: f 4 71 f1 p ' 9 Authority having s ' ction Contact: ► Ti Y��+`� Time: ) C) Location of UPS Calculated capac y of UP b tteries to drive the system components connected to it: Other, if require Contact: Time: In alarm mode (minutes): ',;„ In standby mode (hours): 7. TESTING RESULTS 4.2.4 Batteries 7.1 Control Unit and Related Equipment Location: Type: Nominal voltage: Amp/hour rating: A . vi • rive the s stem: Visual Functional Calculated capacity b ttz Y Description Ins ection Test In standby mode (h r Comments � In alarm mode (minutes): ❑ Control unit I ❑ Batteries are marked with date of manufacture. LampsILEDs/LCDa ❑ , 4.3 Notification Applian e Power Extender Panels ❑ This system does not have power extender panels. Fuses ❑ ❑ 4.3.1 Primary Pow Trouble signals Yb ❑ Input voltage of pow nde p e (s : Power extender panel amps: Disconnect switches P' ❑ 4.3.2 Engine- Driven Gener for ❑ This system does not have a generator. Ground -fault monitoring �. ❑ Location of generator: Supervision ❑ Location of fuel storage: . Type of fuel: Local annunciator 1:iki ❑ 4.3.3 Uninterruptible P. i er stem ❑ This system does not have a UPS. Remote annunciators ❑ Equipment powered . . a ' S sy •m: Power extender panels ❑ ❑ Location of UPS sys i Isolation modules ❑ ❑ Calculated capacity if 'S • at ries to drive the system components connected to it: Other (specify) ❑ ❑ • In standby mode (hours): In alarm mode (minutes): NFPA 72 (p. 3 of 11) ® 2009 National Fire Protection Association NFPA 72 (p. 4 of 11) ®2009 National Fire Protection Association FIGURE 14.6.2.4 Continued FIGURE 14.6.2.4 Continued ii 1 2010 Edition 2010 Edition • 72 NATIONAL FIRE ALARM AND SIGNALING CODE INSPECTION, TESTING, AND MAINTENANCE 72 7. TESTING RESULTS (continued) 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies 7.4 Notification Appliance Power Extender Panels Visual Functional Visual Functional Description Inspection Test Comments Description Inspection Test Comments 120 volt power )133 ❑ Lamps/LEDs/LCDs ❑ Generator or UPS ❑ ❑ Fuses ❑ Battery condition "O ❑ Primary power supply a- 0 Load voltage 0 Secondary power supply ❑ • Discharge test 4 ❑ Trouble signals 0 Charger test )6:11 ❑ Ground -fault monitoring 91°. ❑ Other (specify) 0 ❑ Panel supervision �i' ❑ • Other (specify) ❑ ❑ 7.3 In- Building Fire Emergency Voice Alarm Communications Equipment 7.5 Mass Notification Equi3e V isual Functional Description Inspection Test Comments • Visual Functional Control unit 0 Description Inspection Test Comments Lamps/LEDs/LCDs U yo ❑ Functional test ❑ ❑ Fuses 0 Reset /power down test ❑ 0 ,, , n' S Is Primary power supply ❑ Fuses ❑ ❑ power supply ❑ Primary power supply U D Secondary p Trouble signals '' ❑ UPS power test ❑ 0 - Disconnect switches ❑ Trouble signals ❑ ❑ Ground -fault monitoring P ❑ Disconnect switches 0 ❑ Ground -fault monitoring 0 ❑ ' Panel supervision ❑ System performance ❑ CCU security mechanism 1] ❑ Sound pressure levels Y ❑ Prerecorded message GI content Occupied ❑ Yes ❑ No Prerecorded message ❑ ❑ Ambient dBA activation Alarm dBA Software backup performed ❑ ❑ (attach report with locations, • values, and weather conditions) Test backup software ❑ ❑ System intelligibility ❑ 0 Fire alarm to MNS interfa ❑ ❑ ❑CSI ❑STI MNS to fire alarm interface 0 ❑ (attach report with locations, values, and weather conditions) In - building MNS to ❑ ❑ Other (specify) ❑ ❑ wide - area MNS 0 2009 National Fire Protection Association NFPA 72 (p. 5 of 11) ®2009 National Fire Protection Association NFPA 72 (p. 6 of 11) ' ' 9 FIGURE 14.6.2.4 Continued FIGURE 14.6.2.4 Continued 2010 Edition 2010 Edition 4 X 1 _ 72 -84 ._ _ . T NATIONAL FIRE ALARM AND SIGNALING CODE I INSPECTION, TESTING, AND MAINTENANCE 72 -85 7. TESTING RESULTS (continued 7. TESTING RESULTS (continued) 7.7 Combination Systems 7.5 Mass Notification Equipmen>o ed) Visual Functional Vi Functional Description Inspection Test Comments Description Inspection tion Test Comments ❑ Fire extinguishing monitoring ❑ ❑ MNS to direct recipient MNS ❑ devices/system Sound pressure levels ❑ ❑ Carbon monoxide ❑ ❑ Occupied ❑ Yes ❑ No detector /system Ambient dBA Combination fire/ ❑ ❑ Alarm dBA security system (attach report with locations, Other (specify) ❑ ❑ values, and weather conditions) System intelligibility ❑ ❑ CI CSI ❑ STI 7.8 Special Hazard System ir (attach report with locations, values, and weather conditions) Visual Functional Description (specify) Inspection Test Comments Other (specify) ❑ ❑ ❑ ❑ ❑ ❑ 7.6 Two -Way Communications Equipment ❑ ❑ Visual Functional Description Inspection Test Comments ❑ ❑ 7.9 Emergency Communications System !' Phone handsets i — ID Visual Phone jacks i)1::' ❑ ❑ Functional Off -hook indicator ❑ ❑ ❑ Simulated operation Call-in signal ❑ ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. System performance ❑ See NFPA 72, 24.4.1.7.1. System audibility ❑ 7.10 Monitored Systems System intelligibility ❑ ❑ Visual Functional Radio communications ❑ ❑ Description (specify) Inspection Test Comments enhancement system Engine -driven generator ❑ ❑ Area of refuge ❑ ❑ communication system Fire pump ❑ ❑ Elevator emergency ❑ ❑ Special suppression systems ❑ ❑ communications system Other (specify) ❑ ❑ Other (specify) ❑ ❑ NFPA 72 (p. 7 of 11) © 2009 National Fire Protection Association NFPA 72 (p. 8 of 11) © 2009 National Fire Protection Association fi FIGURE 14.6.2.4 Continued FIGURE 14.6.2.4 Continued 2010 Edition 2010 Edition • 72-86 NATIONAL FIRE ALARM AND SIGNALING CODE INSPECTION, TESTING, AND MAINTENANCE 72-87 8. NOTIFICATIONS THAT TESTING IS COMPLETE 7. TESTING RESULTS (continued) �y _` Monitoring organization Contact: .l' 171 (-- 1 Time: ' YO 7.11 Auxiliary Functions Building management Contact: Time: Visual Functional Bu ilding occupants Contact: 7331-4— Time: ` Comments Description Inspection Test Authority having jurisdiction Contact: ai'C.� Time: p9 r Door- releasing devices ❑ Other, if required Contact: e 1�� 0 F 11 ciD I t' Time: 1 , 0 Fan shutdown y ❑ Smoke management/ 0 9. SYSTEM RESTORED TO NORMAL OPERATION Smoke control 9"- ` Y d fr Date: q' ' 2 Z Time: Smoke damper operation r ❑ Smoke shutter release ❑ ❑ 10. CERTIFICATION Door unlocking ❑ ❑ 10.1 Inspector Certification: Elevator recall ❑ ❑ This system, as specified herein, has been inspected and tested according to all NFPA standards cited herein. Elevator shunt trip ❑ ❑ MNS override signals D a ide of FA si als ❑ ❑ Signed: Printed name: �C I � � t Date: D `Z� 1 2. Other (specify) ❑ ❑ Organ' ation: 4iJ i Fee- Title: p CZ- D Tt Phone: 5b3 907 10.2 Acceptance by Owner or Owner's Representative: 7.12 Alarm Initiating Device ❑ Device test results sheet attached listing all devices tested and the results of the testing The undersigned has a service contract for this system in effect as of the date shown below. 7.13 Supervisory Alarm Initiating Device Signed: Printed name: Date: ❑ Device test results sheet attached listing all devices tested and the results of the testing Organization: Title: Phone: 7.14 Alarm Notification Appliances ❑ Appliance test results sheet attached listing all appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description Yes No Time Comments Alarm signal Itr-" ❑ Alarm restoration >4) ❑ Trouble signal NO ❑ Trouble restoration /9 ❑ Supervisory signal ❑ Supervisory restoration ❑ NFPA 72 (p. 9 of 11) © 2009 National Fire Protection Association NFPA 72 (p. 10 of 11) ® 2009 National Fire Protection Association - FIGURE 14.6.2.4 Continued FIGURE 14.6.2.4 Continued l 2010 Edition L 2010 Edition