SYSTEM RECORD OF INSPECTION AND TESTING

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

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Inspection/Test Completion Date/Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Supplemental Forms Attached
Name of property
Address
Description of property
Name of property representative
Representative Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
2. TESTING AND MONITORING INFORMATION
Testing organization
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Monitoring organization
Monitoring Organization Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax
Format: (000) 000-0000.
Email
example@example.com
Account Number
Phone line 1
Format: (000) 000-0000.
Phone line 2
Format: (000) 000-0000.
Means of transmission
Entity to which alarms are retransmitted:
Phone
Format: (000) 000-0000.
3. DOCUMENTATION
On-site location of the required record documents and site-specific software
4. DESCRIPTION OF SYSTEM OR SERVICE
4.1 Control Unit
Model number
4.2 SOFTWARE & 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
4.3.2 Seconday 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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Building Management / Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Building Occupants / Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Authority having jurisdiction / Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Other, if required / Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
6. TESTING RESULTS

6.1 Control Unit and Related Equipment

Rows	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
Additional

6.2 Secondary Power

Rows	Visual Inspection	Functional Test	Comments
Battery Condition
Load Voltage
Discharge Test
Charger Test
Remote Panel Batteries

6.3 Alarm and Supervisory Alarm Initiating Device

Attach supplementary device test sheets for all initiating devices.

Attach supplementary appliance test sheets for all notification appliances.

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

Rows	Not Satisfied	Somewhat Satisfied	Time	Comments
Service Quality
Cleanliness
Responsiveness
Friendliness
Supervisory Signal
Supervisory Restoration

6.7 Public Emergency Alarm Reporting System

Rows	Yes	No	Time	Comments
Alarm Signal
Alarm Restoration
Trouble Signal
Trouble Restoration
Supervisory Signal
Supervisory Restoration

7. NOTIFICATIONS THAT TESTING IS COMPLETE
Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Contact
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
8. SYSTEM RESTORED TO NORMAL OPERATION
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time

Hour Minutes

AM/PM Option
This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14.
Signature
Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Organization
Title
Phone
Format: (000) 000-0000.
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:
Signature
Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Organization
Title
Phone
Format: (000) 000-0000.
Should be Empty: