Fire Alarm System

GENERAL INFORMATION
Facility: / Contact Name:
Street Address: / Phone#: / Fax#:
City, State, Zip: / Group Info:
Panel Manufacturer: / Model: / Dialer Manufacturer: / Model:
Panel owned or leased: Owned / Monitoring Company:
Last Inspection: / Next Inspection Due:
Service Company:
CONTROL SYSTEM
Panel / Remote Transponder
/ Qty: 1
Manufacturer:
Type (addressable or conventional):
addressableconventional
Model #:
Batteries (Qty and size): 2 / 7.5 AH
/ / Qty: 0
Type (addressable or conventional):
addressableconventional
Batteries (Qty and size):
Remote Annunciators / Amplifier
/ Qty: 0
Type (addressable or conventional):
addressableconventional
/ / Qty: 0
Type (addressable or conventional):
addressableconventional
Batteries (Qty and size):
NCCNT Computer / Power Booster
/ Qty: 0
/ / Qty: 0
Batteries (Qty and size):
DETECTION AND INITIATING DEVICES
Heat Detectors / Duct Detectors
/ Qty Rate of Rise:
Qty Fixed Temp:
Qty Addressable: 0
/ / Qty Conventional: 0
Qty Addressable: 0
Smoke Detectors / Single-Station Smoke Detectors
/ Qty Conventional:
Qty Addressable: 0
/ / Qty:
Supervised by fire alarm system?
YesNo
Beam Smoke Detectors / Pull Stations
/ Qty: 0
/ / Qty Conventional: 0
Qty Addressable: 0
Tamper Switches / Supervisory Switches
Qty: 0
/ / Qty: 0
DETECTION AND INITIATING DEVICES Continued
Water Flow Switches / Monitor Module/ Relay Module
/ Qty: 0
/ / Qty: 0
NOTIFICATION APPLIANCES
Horns/Horn Strobes; Speakers/Speaker Strobes; Strobes / Auto Door Drops
/ Qty Horns:
Qty Horn Strobes: 10
Qty Speakers:
Qty Speaker Strobes:
Qty Strobes:
Manufacturer: Firelite
/ / Qty Auto Door Drops: 0
ACCESSORIES
Magnetic Door Holders / Fireman’s Phone Jack
/ Qty Magnetic Door Holders: 3
/ / Qty: 0
Fire Fighter Phones / Digital Dialer (DACT)
/ Qty: 0
/ / Type (internal, external, combination panel (Security/Fire): InternalExternalCombination Panel (Security/Fire)
Keypad? YesNo
Manufacturer: Monaco model BT-X transceiver

Sprinkler Systems

GENERAL INFORMATION
Last Inspection: / Next Inspection Due:
Service Company:
Wet Pipe Sprinkler Systems / Private Fire Hydrants
/ Qty (# of risers):
# of Floors served:
/ / Qty:
Dry Pipe Sprinkler Systems / Fire Pumps
/ Qty (# of risers):
# of Floors served:
/ / Qty:
Type (Electric or Diesel): ElectricDiesel
Size:
GPM:
Preaction Sprinkler Systems / Fire Sprinkler Backflow Preventer
/ Qty (# of risers):
Control Panel:
Qty Smoke detectors:
/ / Qty:
Size:

Suppression Systems

GENERAL INFORMATION
Last Inspection: / Next Inspection Due:
Service Company: none
Fire Extinguishers / Special Hazard Systems
/ Qty 5 lb: 0
Qty Other (specify): 25 10 LBS 4A:80BC
/ / Control Panel: 0
Number of tanks:
Type (Halon, Inergin, CO2, Sinorix, Foam-water,
Deluge): HalonInerginCO2FM200SinerixFoam-waterDeluge
Pounds of suppressant:
Kitchen Fire Suppression Systems / Air Sampling Systems (VESDA)
/ Qty:
Manufacturer: Range Guard
# of cylinders (tanks) per system:
# of fuseable links:
/ / # of Pipes:
Length of Pipes:

Exit Signs and Emergency Lights

GENERAL INFORMATION
Last Inspection: / Next Inspection Due:
Service Company:
Emergency Lighting / Combo Exit Sign / Emergency Lighting
/ Qty:
Internal Backup / external backup?
Internal backupExternal backup
If external, please specify (generator,
direct Power, battery):
GeneratorDirect powerBattery
/ / Qty: 0
Internal Backup / external backup?
Internal backupExternal backup
If external, please specify (generator,
direct Power, battery):
GeneratorDirect powerBattery
Exit Signs
/ Qty:
Internal Backup / external backup?
Internal backupExternal backup
If external, please specify (generator,
direct Power, battery):
GeneratorDirect powerBattery

Additional Information Required for Testing

High Ceilings
Please advise if any of your buildings have high ceilings or atriums. / Yes / No: YesNo
Lifts
Please advise if lifts are required to perform testing. Lifts are typically required if your facility has atriums or ceilings higher than 40 feet. / Yes / No: YesNo
Duration (days / weeks):
Maximum ceiling height:
Type of lift needed / acceptable:
Accessibility
Please advise if your buildings include rooms which require special access. / # rooms req. special access: 2
Special access requirements (keys, personnel assistance, etc.): keys and escort
After Hours requirements
Please advise whether your facility requires after hours work to be performed and note special hours when your buildings are available for testing. / Yes / No: YesNo
If yes, note special hours: