Fire Alarm Test ReportP.O. Box 767
15 Cooper Street
Glens Falls, NY 12801
Fire Alarm Inspection and Testing Form
Glens Falls
(518) 793-7788
Plattsburgh
(518) 566-9147
Lake Placid
(518) 523-1600
Toll Free
(800) 794-6277
Fax
(518)793-0602
Customer
Control Unit
Name: ^� "' ,v
Manufacturer:
Address:
Model:
Last Service Date:
Voltage:
Owner/Contact:
Dialer Manufacturer:
Phone Number:
Today's Date: wit ; Start Time : ; End Time : ;,�!y;�
Dialer Model:
('e Voltage: t,
IVOOTIcations are Maae Prior to and/ 1 esLmg
Monitoring Entity Fi Yes F7 No Time
Building Occupants/Manager F Yes r No Time
[Backup
mmunication Type �h', DID Network P!; Radio �, Reverse Polarity Cellular
ckup Communication � Yes (', No Type: F DD �, Network Radio Reverse Polarity cellular
Communicator Battery �` Pass F Fail
Quantity
Tested
Class
Test Type
Result
F_
A
r—,_
B
Manual Fire Alarm Boxes
P Visual
r. Functional
F
Pass
F—
Fall
rl
A
J-
B
F-i Visual
F-I Functional
P,
Pass
P
Fail
r,
A
PZ
B
Photo Detectors
Fv�lisual
✓ Functional
Pass
P
Fail
q
B
Duct Detectors
Visual
Functional
r
Pass
F
Fail
r
A
r-
B
Heat Detectors
F- Visual
F-, Functional
[7
Pass
F-j
Fall
(-
A
F-,
B
Waternow Switches
P Visual
[ Functional
F,
Pass
F-',
Fail
r-
A
F-
B
Fire Doors
F Visual
r, Functional
r,
Pass
P
Fail
A
F—I
B
Bells +Horns
f— Visual
F,,Functional
j—,
Pass
F-
Fail
-
F-j
A
P i
B
Horn/Strobes
F7 Visual
F,,r Functional
i
Pass
rj
Fail
3
F
A
P
B
Strobes
r Visual
Functional
F,-
Pass
r-;
Fall
--Notification
devices have 2HR fire -rated cable assembly
F—:. Yes
F`. No
r
A
F—
B
Speakers
F Visual
F-'
Functional
f-.
Pass
r;
Fail
r,
A
(—,.
B
Sprinkler Valve Supervisory
P Visual
r'I
Functional
I,
Pass
j—,
Fail
F-;
A
P
B
r", Visual
F-1
Functional
rj
Pass
r!
Fail
j-
A
F-j
B
Pj Visual
(-
Functional
F-i
Pass
rl
Fail
rl
A
Pj
B
Beam Detectors
r; Visual
(-
Functional
r;
Pass
F-i
Fall
[I
A
r-i,
B
Sprinkler Low Temp
F- Visual
F-i
Functional
F-i
Pass
F-
Fall
rl
A
f7
B
Sprinkler Low Air
F": Visual
F-I
Functional
r;
Pass
j—,:
Fall
F-1
A
F-
B
Fire Pump
F- Visual
ri,
Functional
F-;
Pass
F-
Fall
System Tests and Inspections
Device
Test Type
Device
Test
Type
Control Unit
r Visual
r,, Functional
Audible Notification Devices
Fj Visual
[ i{ Functional
Lamps/LEDs
F-,, Visual
r; Functional
Visible Notification Devices
r Visual
r, Functional
Trouble Signals
rj Visual
I—! Functional
Telephone Line(s)/Network
r, Visual
F/-Functional
System Power Supply
Dedicated Circuit
j—i
Yes r No r Unknown
Panelboard and Circuit Breaker Designation
r!
Yes rj No r',. Unknown
--
Circuit Number is Labeled on Fire Alarm Control
Unit r"',,
Yes r—j No ri Unknown
Disconnecting Means is Secured
r',
Yes r No r— Unknown
Disconnecting Means is Clearly Labeled
r,,
Yes r No r;; Unknown
Batteries
Type:
Qty:
Type:
Qty:
Date of Install:
or Unknown r
Date of Install:
or Unknown r—i,
Charger Test
rl Pass r"j Fail
r Unknown
Charger Test r, Pass
r Fail
r, Unknown
Load Voltage
rl Pass [-j Fail
rUnknown
Load Voltage r, Pass
r' Fail
rj Unknown
Discharge Test
rl Pass r'j Fail
r Unknown
Discharge Test r Pass
j— Fail
f7 Unknown
Battery Condition
r) Pass rl Fail
j—I, Unknown
Battery Condition r Pass
rj Fail
r Unknown
Have any devices been added since the last inspection? 57< Yes
r No
11t
Is the fire alarm control unit protected by a smoke detector? F,7 Yes
r No
i ^4(A
Was the transmission of alarm events to the Central Station confirmed? f` Yes
r No
Dispatcher's ID
T)y
Monitoring Agency
r--�,- Yes ❑ No
Have the following been notified that testing is complete?
Building Occupants/Management
F<-) Yes r'; No
Is the system functioning normally? �, Yes
r No
WIT,7,71--'
This testing was performed
in accordance with NFPA 72
Name of Inspecting Technician: �,
Name of Owner or Representative
W,
Technician's signature: as�
Signature of Owner or Rep:
Date: Vj'K b, Time:
Date:
Time:
MNI 5/09