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SYSTEM RECORD OF INSPECTION AND TESTING This form is to be completed by the system inspection and testing contractor at the time of a system test. 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 necessary to provide a complete record.
Inspection/Test Start Date/Time:
Inspection/Test Completion Date/Time:
Supplemental Form(s) Attached:
(yes/no)
1. PROPERTY INFORMATION Name of property: Address: Description of property: Name of property representative: Address: Phone:
Fax:
E-mail:
2. TESTING AND MONITORING INFORMATION Testing organization: Address: Phone:
Fax:
E-mail:
Fax:
E-mail:
Monitoring organization: Address: Phone: Account number:
Phone line 1:
Phone line 2:
Means of transmission: Entity to which alarms are retransmitted:
Phone:
3. DOCUMENTATION On-site location of the required record documents and site-specific software:
4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer:
Model number:
4.2 Software and Firmware Firmware revision number:
4.3 System Power 4.3.1 Primary (Main) Power Nominal voltage:
Amps:
Location:
Overcurrent protection type:
Amps:
Disconnecting means location:
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 1 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued)
4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type:
Location:
Battery type (if applicable): Calculated capacity of batteries to drive the system: In standby mode (hours):
In alarm mode (minutes):
5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization
Contact:
Time:
Building management
Contact:
Time:
Building occupants
Contact:
Time:
Authority having jurisdiction
Contact:
Time:
Other, if required
Contact:
Time:
6. TESTING RESULTS 6.1 Control Unit and Related Equipment
Description
Visual Inspection
Functional Test
Comments
Visual Inspection
Functional Test
Comments
Control unit Lamps/LEDs/LCDs Fuses Trouble signals Disconnect switches Ground-fault monitoring Supervision Local annunciator Remote annunciators Remote power panels
6.2 Secondary Power
Description Battery condition Load voltage Discharge test Charger test Remote panel batteries
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 2 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued) 6. TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices.
6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances.
6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface / Signaling Line Circuit Interface / Fire Alarm Control Interface
6.6 Supervising Station Monitoring Description
Yes
No
Time
Comments
No
Time
Comments
Alarm signal Alarm restoration Trouble signal Trouble restoration Supervisory signal Supervisory restoration
6.7 Public Emergency Alarm Reporting System Description
Yes
Alarm signal Alarm restoration Trouble signal Trouble restoration Supervisory signal Supervisory restoration
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 3 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued)
7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization
Contact:
Time:
Building management
Contact:
Time:
Building occupants
Contact:
Time:
Authority having jurisdiction
Contact:
Time:
Other, if required
Contact:
Time:
8. SYSTEM RESTORED TO NORMAL OPERATION Date:
Time:
9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14.
Signed:
Printed name:
Date:
Organization:
Title:
Phone:
Qualifications (refer to 10.5.3):
10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE
10.1 Acceptance by Owner or Owner’s Representative: The undersigned accepted the test report for the system as specified herein:
Signed:
Printed name:
Date:
Organization:
Title:
Phone:
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 4 of 4)
Inspection/Test Start Date/Time:
Inspection/Test Completion Date/Time:
Supplemental Form(s) Attached:
(yes/no)
1. PROPERTY INFORMATION Name of property: Address: Description of property: Name of property representative: Address: Phone:
Fax:
E-mail:
2. TESTING AND MONITORING INFORMATION Testing organization: Address: Phone:
Fax:
E-mail:
Fax:
E-mail:
Monitoring organization: Address: Phone: Account number:
Phone line 1:
Phone line 2:
Means of transmission: Entity to which alarms are retransmitted:
Phone:
3. DOCUMENTATION On-site location of the required record documents and site-specific software:
4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer:
Model number:
4.2 Software and Firmware Firmware revision number:
4.3 System Power 4.3.1 Primary (Main) Power Nominal voltage:
Amps:
Location:
Overcurrent protection type:
Amps:
Disconnecting means location:
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 1 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued)
4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type:
Location:
Battery type (if applicable): Calculated capacity of batteries to drive the system: In standby mode (hours):
In alarm mode (minutes):
5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization
Contact:
Time:
Building management
Contact:
Time:
Building occupants
Contact:
Time:
Authority having jurisdiction
Contact:
Time:
Other, if required
Contact:
Time:
6. TESTING RESULTS 6.1 Control Unit and Related Equipment
Description
Visual Inspection
Functional Test
Comments
Visual Inspection
Functional Test
Comments
Control unit Lamps/LEDs/LCDs Fuses Trouble signals Disconnect switches Ground-fault monitoring Supervision Local annunciator Remote annunciators Remote power panels
6.2 Secondary Power
Description Battery condition Load voltage Discharge test Charger test Remote panel batteries
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 2 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued) 6. TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices.
6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances.
6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface / Signaling Line Circuit Interface / Fire Alarm Control Interface
6.6 Supervising Station Monitoring Description
Yes
No
Time
Comments
No
Time
Comments
Alarm signal Alarm restoration Trouble signal Trouble restoration Supervisory signal Supervisory restoration
6.7 Public Emergency Alarm Reporting System Description
Yes
Alarm signal Alarm restoration Trouble signal Trouble restoration Supervisory signal Supervisory restoration
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 3 of 4)
SYSTEM RECORD OF INSPECTION AND TESTING (continued)
7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization
Contact:
Time:
Building management
Contact:
Time:
Building occupants
Contact:
Time:
Authority having jurisdiction
Contact:
Time:
Other, if required
Contact:
Time:
8. SYSTEM RESTORED TO NORMAL OPERATION Date:
Time:
9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14.
Signed:
Printed name:
Date:
Organization:
Title:
Phone:
Qualifications (refer to 10.5.3):
10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE
10.1 Acceptance by Owner or Owner’s Representative: The undersigned accepted the test report for the system as specified herein:
Signed:
Printed name:
Date:
Organization:
Title:
Phone:
Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 4 of 4)
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