FIRE ALARM INSPECTION REPORT
TESTING PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS
Inspected On:
July 23, 2007
Client
Test Customer
65 Test Ave.
Sample, OH 44444
111-111-1111
Property Location
Test Building 4625 North Ave.
Sample, OH 44444
Monitoring Agency
Emergency 24
1-800-877-3624
Genesis Building Systems, Ltd.
737 North Wilson Road., Columbus, OH 43204
(614) 272-6868 / Fax: (614) 272-6965
License No. 52-25-26
Test Customer
Test Building 4625 North Ave.
07/23/2007
Inspector Summary
July 2007 Inspection:
100% Pull Stations
100% Smoke Detectors
100% Duct Detectors
100% Door Holders
100% Signals
Complete Panel Test
1
Test Customer
Test Building 4625 North Ave.
07/23/2007
Control Panel Test Results
Control Panel Manufacturer: Simplex
Model Number: 4010-9101
Serial Number: NSN
Panel Location: Main Office
Circuit Breaker Location:
Test Performed Result Value Note
Control Functions Pass
Fuses Pass
Lamps/LEDs Pass
Trouble Signals Pass
Disconnect Switches Pass
Ground Fault Monitoring Pass
Voltage with Charger Pass 26.7
Voltage without Charger Pass 26.7
Battery #1 % of Charge Pass 100%
Battery #2 % of Charge Pass 100%
Battery Age Check Pass 2007
AC Input Voltage Pass 124.0
Note
12AH
Control Panel Manufacturer: Simplex
Model Number: 4009-9001
Serial Number: NSN
Panel Location: Main Office Left
Circuit Breaker Location:
Test Performed Result Value Note
Control Functions Pass
Fuses Pass
Lamps/LEDs Pass
Trouble Signals Pass
Disconnect Switches Pass
Ground Fault Monitoring Pass
Voltage with Charger Pass 27.3
Voltage without Charger Pass 27.3
Battery #1 % of Charge Pass 80%
Battery #2 % of Charge Pass 80%
Battery Age Check Pass
AC Input Voltage Pass 124.0
Note
7AH
2
Test Customer
Test Building 4625 North Ave.
07/23/2007
Control Panel Manufacturer: Simplex
Model Number: 4009-9001
Serial Number: NSN
Panel Location: Main Office Right
Circuit Breaker Location:
Test Performed Result Value Note
Control Functions Pass
Fuses Pass
Lamps/LEDs Pass
Trouble Signals Pass
Disconnect Switches Pass
Ground Fault Monitoring Pass
Voltage with Charger Pass 27.3
Voltage without Charger Pass 27.3
Battery #1 % of Charge Pass 80%
Battery #2 % of Charge Pass 80%
Battery Age Check Pass
AC Input Voltage Pass 124.0
Note
7AH
3
Test Customer
Test Building 4625 North Ave.
07/23/2007
Alarm Initiating Device Test Results
Device Description Passed Failed Not Tested Total
ADD Analog Duct Detector 9 0 0 9
ASD Analog Smoke Detectors 8 0 0 8
PULL Manual Fire Alarm Box 10 1 0 11
27 1 0 28
Device Floor Location Zone Result Sens. Note
ADD 1 Kitchen Platform AHU 5 M1-6 Pass 2.5%
ADD 1 Kitchen Platform AHU 6 M1-7 Pass 2.5%
ADD 1 Kitchen Platform AHU 7 M1-8 Pass 2.5%
ASD 1 Above Fire Alarm Panel in Office M1-50 Pass 2.5%
ASD 1 Elevator Lobby M1-26 Pass 2.5%
ASD 1 Elevator Machine Room M1-22 Pass 2.5%
ASD 1 Mechanical Room 164 M1-13 Pass 2.5%
ASD 1 Room 120 Above Kiln M1-42 Pass 2.5%
ASD 1 Switchgear Room M1-12 Pass 2.5%
PULL 1 Area A South Exit M1-19 Pass
PULL 1 Area A West Exit M1-18 Pass
PULL 1 Area B East Exit M1-1 Pass
PULL 1 Area B Gym North Exit M1-3 Pass
PULL 1 Area B Gym Southeast Exit M1-4 Pass
PULL 1 Area B Gym Southeast Exit M1-2 Pass
PULL 1 Area B Room 154 M1-5 Pass
PULL 1 Area B West Exit M1-17 Pass
PULL 1 Mechanical Room 162 M1-11 Pass
ADD 2 Mechanical Room AHU 10 M1-35 Pass 2.5%
ADD 2 Mechanical Room AHU 11 M1-38 Pass 2.5%
ADD 2 Mechanical Room AHU 2 M1-36 Pass 2.5%
ADD 2 Mechanical Room AHU 3 M1-33 Pass 2.5%
ADD 2 Mechanical Room AHU 4 M1-34 Pass 2.5%
ADD 2 Mechanical Room AHU 5 M1-37 Pass 2.5%
ASD 2 Elevator Lobby M1-31 Pass 2.5%
ASD 2 Top of Elevator Shaft M1-28 Pass 2.5%
PULL 2 East Stairs M1-32 Fail Cover is broken
PULL 2 West Stairs M1-40 Pass
4
Test Customer
Test Building 4625 North Ave.
07/23/2007
Alarm Indicating Device Test Results
Device Description Passed Failed Not Tested Total
HN/STB Horn Strobe 23 1 0 24
STROBE Strobe 13 0 0 13
36 1 0 37
Device Floor Location Result Note
HN/STB 1 By West Mechanical Room Pass
HN/STB 1 Main Entrance Pass
HN/STB 1 Library North Wall Pass
HN/STB 1 Library North Pass
HN/STB 1 Gym West Pass
HN/STB 1 Gym South Pass
HN/STB 1 Gym North Pass
HN/STB 1 By Elevator Pass
HN/STB 1 Cafeteria Fail Visual fails
HN/STB 1 Outside Library Pass
HN/STB 1 By Vending Area Pass
HN/STB 1 By Room 117 Pass
HN/STB 1 By Room 115 Pass
HN/STB 1 By Room 111 Pass
HN/STB 1 By Room 110 Pass
HN/STB 1 By Room 107 Pass
HN/STB 1 By Room 103 Pass
HN/STB 1 Eating Area Pass
HN/STB 1 Office Pass
HN/STB 1 Outside by Room 107 Pass
HN/STB 1 West Mechanical Room Pass
HN/STB 1 Room 103 Pass
HN/STB 1 Outside of Office Pass
HN/STB 1 Outside Main Entrance Pass
STROBE 1 Girls Restroom by Elevator Pass
STROBE 1 Room 107 Pass
STROBE 1 Room 106 Pass
STROBE 1 Room 105 Pass
STROBE 1 Room 102 Pass
STROBE 1 Room 101 Pass
STROBE 1 Office Womens Restroom Pass
STROBE 1 Office Mens Restroom Pass
STROBE 1 Girls Restroom by Room 117 Pass
STROBE 1 Boys Restroom by Room 117 Pass
STROBE 1 Boys Restroom by Elevator Pass
STROBE 1 Room 109 Pass
STROBE 1 In South Stairwell Pass
5
Test Customer
Test Building 4625 North Ave.
07/23/2007
Auxiliary Device Test Results
Device Description Passed Failed Not Tested Total
DH Door Holder 6 0 0 6
6 0 0 6
Device Floor Location Result Note
DH 1 South Stairs Pass
DH 1 West Stairs Pass
DH 1 West Stairs Pass
DH 2 South Stairs Pass
DH 2 West Stairs Pass
DH 2 West Stairs Pass
6
Test Customer
Test Building 4625 North Ave.
07/23/2007
Deficiency Summary
Device Floor Location Zone Sens. Note
Initiating Devices
27 PULL 2 East Stairs M1-32 Cover is broken
Indicating Devices
10 HN/STB 1 Cafeteria Visual fails
Notes
The testing was performed in accordance with applicable NFPA standards.
Inspector: Joe Inspector 54-25-????
(signature)
Customer:
(signature)
