Inspection Reports

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Report Type *

Inspector Information

Inspection Company *

SUP Service Tech, License/Permit No. (Boss Fire & Safety) *

SUP Service Tech, License/Permit No. (Boss Fire Protection) *

SPR Service Tech, Privilege No. (Boss Fire Protection) *

ALA Service Tech, Privilege No. (Boss Fire Protection) *

SUP Service Tech, License/Permit No. (Viper Fire Protection) *

Technician Email

A copy of the report will be sent upon completion.

Service Tech Name *

First

Last

Other technician(s) on-site?

Service Technician Name

Service Date, Time In *

Date

Time

Customer Information

Customer Name *

Owner/Manager Contact *

Contact Phone *

Contact Email *

A copy of the report will be sent upon completion.

OR/WA Address *

Address Line 1

Address Line 2

City

State

Zip Code

UT Address *

Address Line 1

Address Line 2

City

State

Zip Code

AZ Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Service & Inspection Information

1. Location of extinguisher in designated place & no obstruction to access or visibility of extinguisher *

2. Pressure gauge reading or indicator in the operable range or position *

3. Each fire extinguisher shall have a tag or label securely attached that indicated that maintenance was performed *

4. Do all areas have the correct type & size of extinguisher to protect the hazard *

Number of fire extinguishers inspected *

Suppression Service Type *

Annual
Semi-Annual
Recharge
Installation
Renovation
Repair

Sprinkler Service Type *

Annual
5 Year

Alarm Service Type *

Annual
Semi-Annual
Quarterly

Previous Service

Last Recharge Date

Last Hydro Date

Next Recharge Date *

Next Recharge Date

Next Hydro Date *

Next Hydro Date

System Information

System Type *

UL 300 *

Manufacturer *

Manufacture Year *

Model *

Serial Number *

Dry System Information

Manufacturer *

Manufacture Year *

Model *

Serial Number *

UL 1254 *

Location of System Cylinders *

Cylinder Size, Master *

Cylinder Size, Slave 1

Cylinder Size, Slave 2

Shut-Off *

Fuel
Electric
Gas
Other

Other Shut-Off

Cooking Appliance / Equipment Locations: (Left to Right)

Appliance Description

Notes

Kitchen & Appliance Layout / System Coverage Layout *

Upload photo(s) of [kitchen] appliance layout. Make sure photos show position under hood and nozzle coverage.

Links

Enter quantity for each link type

212°

280°

360°

450°

500°

Other (Specify)

Suppression Service Inspection Checklist

Any NO answer requires a description

1. All appliances properly covered with correct nozzles *

2. Duct and plenum covered with correct nozzles *

3. Positioning of all nozzles checked *

4. System installed in accordance with MFG UL listing *

5. Hood/duct penetrations sealed with weld or UL device *

6. Check if seals intact, free of tampering *

7. System fully charged, free from discharge *

8. Pressure gauge in proper range (if gauged) *

9. Check cartridge weight *

10. Inspect cylinder and mount *

11. Clean cylinder and mount *

12. Operate system from terminal link *

13. Test for proper operation from remote pull station *

14. Check operation of micro switch *

15. Check operation of gas valve *

16. Proper nozzle covers in place *

17. Clean nozzles *

18. Replace fuse links *

19. Check travel of cable nuts/S-hooks *

20. Piping & conduit securely bracketed *

21. Proper separation between fryers and flames *

22. Proper clearance flame to filters *

23. Exhaust fan in operating order *

24. All hood filters in place *

25. Fuel shut-off in on position *

26. Manual & remote set/seals in place *

27. System cover(s) replaced *

28. System operation and seals in place *

29. Slave system operational *

30. Fan warning sign on hood *

31. Personnel instructed in manual operation of system *

32. Proper hand portable extinguishers *

33. Portable extinguishers properly serviced *

34. Service & Certification tag on system *

Fire Sprinkler Service Inspection

General

Is building fully sprinklered? *

Is entire sprinkler system in service? *

Has building been modified since last annual inspection? *

Has the system been modified? *

Is system hydraulically calculated? *

If yes, is nameplate legible and securely attached to riser? *

Is water gong functioning? *

Alarm devices free from damage? *

Do main drain tests differ by more than 10% from last inspection? *

Are all areas with wet sprinkler systems heated? *

Are all strainers clean? *

Signals received by monitoring station? *

Gauges replaced or calibrated within the last 5 years? *

Water Supply

What is the source water? Check all that apply *

Utility
Well
Reservoir
Diesel
Electric
Other

Is there a fire pump? *

Fire Pump

Is fire pump in good condition? *

Are reservoirs, tanks, or pressure tanks in good condition? *

Water level in reservoirs or tanks is good? *

Date of last fire pump test:

Leave blank if none.

Valves

How are valves supervised? *

Sealed
Locked
Tamper Switch

Are valves identified with signs? *

Have all valves been operated and exercised? *

Backflow preventer tested within the last 12 months? *

Sprinklers

Is there an adequate supply of spare sprinklers? *

At least 2 of each type? *

If total number of sprinklers is under 300 then at least 6 spare? *

If total number of sprinklers is between 300 and 1000 then at least 12 spare? *

If total number of sprinklers is over 1000 then at least 24 spare? *

Wrenches for each type? *

Free of damage and leaks? *

Free of corrosion, foreign materials, and paint? *

Are paint booth sprinklers covered by a thin plastic or paper bag? *

Installed in proper orientation? *

Fluid in glass bulbs? *

The following information will be used by the lead technician to determine if additional sprinkler testing is required:

Year sprinklers were installed or replaced?

Are there standard response style sprinklers? *

Are there quick response style sprinklers? *

Are there dry or pre-action system sprinklers? *

Pressure Reducing Valves

Locations

In the open position/not leaking? *

Maintaining good downstream pressure? *

In good condition? *

Piping

No leaks or mechanical damage? *

Correct alignment - no external loads? *

Are piping, hangers, and seismic bracing in good condition? *

Fire Department Connections

Locations

Visible and accessible? *

Are identification signs provided? *

Is automatic drain operating correctly? *

Check valve is not leaking? *

Gaskets in place and not damaged? *

Clapper functional? *

Are caps in place? *

Are threads free from damage? *

Couplings or swivels are not damaged and rotate smoothly? *

Type of standpipe and hose system? *

Dry
Wet
None

Standpipe and Hose System

Class of system? *

Class I (For Fire Dept. use)
Class II (For building occupant use)
Class III (Both building occupant and Fire Department use)

Are pressure regulating devices provided? *

Type of regulating device:

Valve hand wheels not broken? *

Free from leaks? *

Hose threads not damaged, reducers and caps in place? *

Length of hose provided? *

None
50 ft.
75 ft.
100 ft.

Type of hose *

Lined
Unlined
N/A

(If unlined hose is presently installed, it may remain in use. However, when it requires replacement only lined hose should be used in accordance with NFPA 14.)

Are shutoff nozzles provided? *

(If "no" nozzles should be replaced with shutoff type in accordance with NFPA 14.)

Date of last hose hydro test:

Hose Cabinets

Hose cabinet lock (in break glass type) is functional? *

Hose cabinet contents are present and accessible? *

Hose has been re-racked with folds in different position? *

If hose is in cabinet, will swing out at least 90 degrees? *

Device List

System Device Type(s)

Anti-freeze System
Dry Pipe System
Pre-Action System
Deluge System
Wet Sprinkler System

Anti-Freeze System

Location

Address

Pressure

System Label

Upstream Valve
Antifreeze Loop

Propolene Glycol

Index by Percentage Volume

Glycerine

Index by Percentage Volume

Freeze Point in Fahrenheit

Closest to Water Supply

Freeze Point in Fahrenheit

Most Remote

Dry Pipe System

Location *

Address *

Cold Area Penetrations Ice Plug Inspection *

Priming Water *

Accelerator Test *

Valve Room Heated *

Flow Alarm Test *

Control Valve *

Air Pressure Levels *

Normal-Low-Trip

Internal Inspection *

Pre-Action System

Location

Address

Cold Area Penetrations Ice Plug Inspection

Priming Water

Detection System Test

Accelerator Test

Valve Room Heated

Flow Alarm Test

Air Pressure Levels

Normal-Low-Trip

Internal Inspection

Deluge System

Location

Address

Water Supply Pressure

Detection System Test

Priming Water

Flow Alarm Test

Discharge Pattern Adequate

Internal Inspection

Wet Sprinkler System

Location *

Address *

Visual *

Functional *

Main Drain Test *

# / #

Flow Alarm Time *

in Seconds

Internal Inspection (5 Year) *

Fire Alarm Testing & Service Inspection

System Normal Upon Commencement *

Note pre-existing conditions below if applicable

Monitoring Information *

Central Station
Remote
Proprietary
Local
Public / Auxiliary

Time placed on test: *

Placed on test by: *

Operator Name or #:

Monitoring Company

Telephone

Account Number:

System Disabling Notes

System Information

Main FACU location *

FACU Panel Password *

FACU Manufacturer *

Panel Model

FACP Location Identified

PASS
FAIL
N/A

Voltage

120 volt only
12VDC24VDC

Asbuilt Drawings *

Available, verified approved sequence of operations
NOT Available, unable to verify approved sequence of operation
N/A

Asbuilt Drawing Location

Interconnected Systems

Door Holders
Elevator Recall
Fire Doors
Fire Smoke Dampers
HVAC
Interior Notification Devices
Pull Station
Smoke / Heat Detector
Sprinkler
Suppression
Other

Fire Alarm Controls

AC Power on LED *

PASS
FAIL

Alarm LED *

PASS
FAIL

System trouble LED *

PASS
FAIL

Reset/Lamp test *

PASS
FAIL

Panel Sounder *

PASS
FAIL

Unit Grounded *

PASS
FAIL

Positive ground fault *

PASS
FAIL

Negative ground fault *

PASS
FAIL

Signal circuit short *

PASS
FAIL

Signal circuit open *

PASS
FAIL

AC disconnect labeled *

PASS
FAIL

AC breaker Locked on *

PASS
FAIL

AC Voltage *

Battery A/H *

Charging Voltage *

System Voltage (Aux) *

Battery voltage (AC off) LB *

PASS
FAIL

Battery voltage (AC off) RB *

PASS
FAIL

Battery load test (LB) *

PASS
FAIL

Battery load test (RB) *

PASS
FAIL

Battery expiration date *

PASS
FAIL

Voice Evacuation? *

Voice Evac

Short test (per Zone) *

PASS
FAIL

Open test (per Zone) *

PASS
FAIL

Ground test (per Zone) *

PASS
FAIL

Test all handsets

Test all phone jacks

Offsite Communication Equipment? *

Offsite Communication Equipment

Manufacturer

Model

Battery A/H

Charging Voltage

Battery Expires

Battery Load (left)

Battery Load (right)

Remote Annunciator? *

Remote Annunciator

Qty

Type

Location(s)

Confirm alarm correlation

Lamp test

Reset switch functional

Local sounder operation verified

Comments:

Digital Alarm Communicator Test *

Contact ID reporting (confirm trip by device type)
Zone Reporting (enter schedule below; confirm trip)

Zone Type *

Note / Schedule

Cell Unit OR Phone Line *

Cell Unit
Phone Line

Correct signal & restoral at CS per zone schedule *

PASS
FAIL

Panel Trouble & Supervisory confirmed at Central Station *

PASS
FAIL

90 Second or less end to end transmission to CS *

PASS
FAIL

RJ31/RJ38 mounted outside FACP *

PASS
FAIL

PRIMARY LINE

Local trouble signal within 4 minutes *

PASS
FAIL

Line trouble at Central Station within 4 minutes *

PASS
FAIL

RJ31/RJ38x wired in/out w/return feed back to MPOE *

PASS
FAIL

Proper line seizure *

PASS
FAIL

SECONDARY LINE

Local trouble signal within 4 minutes *

PASS
FAIL

Line trouble at Central Station within 4 minutes *

PASS
FAIL

RJ31/RJ38x wired in/out w/return feed back to MPOE *

PASS
FAIL

Proper line seizure *

PASS
FAIL

Synchronization verified *

PASS
FAIL
N/A

Audibility confirmed *

PASS
FAIL
N/A

All other outputs verified and working properly *

PASS
FAIL
N/A

Booster / Power Supply Test *

Booster / Power Supply Location *

Battery A/H *

Manufacturer *

Model *

A/C Voltage *

A/C voltage *

PASS
FAIL

Charging Voltage *

PASS
FAIL

Battery Load (Left) *

PASS
FAIL

Battery Load (Right) *

PASS
FAIL

Battery Expires *

AC breaker labeled & protected *

Breaker ID Labeled at Supply *

Booster Panel Location Identified *

Trouble w/no A/C *

Supervision Verified to FACU *

Inspection Device Listing (1-100)

Device Type *

Address / Zones *

Location *

Visual *

PASS
FAIL

Functional *

PASS
FAIL

Comments

Inspection Device Listing (101-200)

Device Type *

Address / Zones *

Location *

Visual *

PASS
FAIL

Functional *

PASS
FAIL

Comments

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Add Deficiency Report *

Deficiency Report

Device Type

Make/Model

Location

Address / Zone

Condition Description

Recommended Action

Notes, Comments, and/or Deficiencies

Note any comments or deficiencies, if needed. Deficiencies should have accompanying service photos.

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Compliance *

Compliant
Compliant with Non-Critical Deficiencies
Non-Compliant

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Service Acknowledgement

On this date, the above system was inspected and operationally tested in accordance with the fire suppression system requirements of NPFA 17 or 17A, 96, and the manufacturer's manual with the results indicated above.

Customer Authorized Agent *

Clear Signature

Signature

Customer Authorized Agent *

Name

Customer Not On Site

Customer not on site at time of service.

Check this box only if the customer was not on site at time of service completion.

Service Technician *

Clear Signature

Signature

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