INSPECTION, TESTING, ANDI MAINTENANCE INSPECTION ANDTESTING FORM  72-101  DATE: TIME: PROPERTY NAME (USER) Name: Address: Owner Contact: Telephone:. APPROVING AGENCY Contact:. Telephone:. SERVICE a Weekly o Monthly a Quarterly Semiannually D Annually 0 Other (Specify). Model No.:  SERVICE ORGANIZATION Name:. Address:. Representative: License. No.: Telephone:. MONITORING ENTITY Contact: Telephone:. Monitoring. Account. Ref. No.:. TYPETRANSMISSION a1 McCulloh 01 Multiplex 0 Digital 01 Reverse Priority F RF 0C Other (Specify). Control Unit Manufacturer: Circuit Styles: Number of Circuits:. Software Rev.:  Last Date System Had Any Service Performed:, Last Date that Any Software or Configuration Was Revised:.  ALARM-NITIATING DEVICES AND CIRCUIT INFORMATION  Quantity  Circuit Style  Manual Fire Alarm Boxes Ion Detectors Photol Detectors Duct Detectors Heat Detectors Waterflow Switches Supervisory Switches Other (Specify):.  Alarm verification: feature is disabled.  enabled.  (NFPAI Inspectiona and Testing, 1of4)  FIGURE 10.6.2.3 Example of an) Inspection and' Testing Form.  2002 Edition    72-102  NATIONALI FIREALARM CODE  ALARM NOTIFICATION. APPLIANCES AND CIRCUIT INFORMATION  Quantity  Circuit Style  Bells Horns Chimes Strobes Speakers Other (Specify):.  No. of alarm notification appliance circuits: Are circuits monitored: fori integrity? o Yes No  SUPERVISORY SIGNAL-INITATING DEVICES AND CIRCUIT INFORMATION  Quantity  Circuit Style  Building Temp. Site Water' Temp. Site Water Level Fire Pumpl Power Fire Pump Running Fire Pump Autol Position Fire Pump orl Pump Controller' Trouble Fire Pump Running Generator In Auto Position Generator or Controller' Trouble Switch' Transfer Generator: Engine Running Other: Style(s). Amps. Amps.  SIGNALING LINE CIRCUITS Quantity. SYSTEMI POWER SUPPLIES (a) Primary (Main): Nominal Voltage. Overcurrent. Protection: Type Location (of] Primary Supply Panelboard): Disconnecting Means Location: (b) Secondary (Standby): Calculated capacity to operate system, inl hours: Location off fuel storage: TYPE BATTERY 0 Dry Cell Nickel-Cadmium Sealed Lead-Acid Lead-Acid Other (Specify):  Quantity and style ofs signaling) line circuits connected tos system (seel NFPA 72, Table 6.6.1):  Storage Battery: Amp-Hr. Rating.  24  60  Engine-driven generator dedicatedi tof fire alarm system:  (c) Emergency or standby system used as a backup to primary powers supply, instead oft using a secondary power supply:  Emergency system describedi inl NFPA 70, Article 700 Legally required standby described in! NFPA 70, Article' 701 requirements ofA Article 700 or 701.  Optional standby system describedi inl NFPA 70, Article 702, which also meetst the performance  (NFPAI Inspection and1 Testing, 2of4)  FIGURE 10.6.2.3 Continued  2002 Edition    INSPECTION, TESTING, ANDI MAINTENANCE  72-103  PRIORTO. ANYTESTING Yes o a 0 0 a Visual 0 a o 0 0 a a a Visual 0  NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified ofAny Impairments TYPE Control Unit Interface Equipment Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault. Monitoring SECONDARY POWER TYPE Battery Condition Load Voltage Discharge' Test Charger Test Specific Gravity TRANSIENT SUPPRESSORS REMOTE ANNUNCIATORS NOTIFICATION. APPLIANCES Audible Visible Speakers Voice Clarity  No 0 a 0 a a Functional D a a 0 0 0 o a Functional 0 a 0 a a a a Factory Setting  Who  Time  SYSTEM TESTS ANDI INSPECTIONS  Comments  Comments  o 0  INITIATING AND SUPERVISORY DEVICETESTS, ANDI INSPECTIONS  Device Type  Visual Functional Check 0 0 a 0 a a  Measured Setting  Loc. & S/N  Test D a o a o o  Pass Fail 0 0 0 a a o D 0 a o  Comments:,  (NFPAI inspection and7 Testing, 3of4)  FIGURE 10.6.2.3 Continued  2002 Edition    72-104  NATONALFIREALARNI CODE  EMERGENCY COMMUNICATIONS EQUIPMENT  Visual 0 0 0 0 a 0 0 Visual 0 0 a a 0 a  Functional 0 0 0 0 0 0 a Device Operation 0 0 o 0 a 0  Comments  Phone Set Phone. Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) Call-in Signal System) Performance INTERFACE EQUIPMENT (Specify). (Specify). (Specify). SPECIAL HAZARD! SYSTEMS (Specify). (Specify). (Specify). Special Procedures:, Comments:.  Simulated Operation o o a D 0 a  SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Trouble Signal Supervisory! Signal Supervisory Restoration Building Management Monitoring Agency Building Occupants Other (Specify)  Yes No a a 0 a a a a o 0 o Yes No 0 a 0 o a a a a  Time  Comments  NOTIFICATIONS THAT TESTING IS COMPLETE  Who  Time  The following did not operate correctly:. System restored tor normal operation: Date:  Time: Date:  THIS TESTING WAS PERFORMED IN ACCORDANCE WITHA APPLICABLE NFPA STANDARDS.  Name ofI Inspector:. Signature:, Name of Owner or Representative:, Date:. Signature:.  Time:  Time:.  (NFPAI Inspection andT Testing, 4of4)  FIGURE 10.6.2.3 Continued  2002 Edition