FSTX NFPA 25 - Annual Inspection Form
Building Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Inspector
First Name
Last Name
License #
Inspection Date
-
Month
-
Day
Year
Date
What type of systems are being inspected?
Wet System
Dry System
Pre-action System
Deluge System
Air Compressor
Standpipe
Hose Valves
PRV
Electric Fire pump
Diesel Fire Pump
3-year
5 year-Internal Inspection
How many Wet Systems
Wet System 1 Name
Wet System 2 Name
Wet System 3 Name
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General System Questions (Questions for all systems, Owner Questions)
Chapter 4
Is building Occupied?
Yes
No
Are all fire protection systems in service?
Yes
No
Fire Protection Systems
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Was the system free of actuation of devices or alarms since the last inspection
Yes
No
Has the occupancy classification and hazard of contents remained the same since the last inspection? 4.1.6
Yes
No
Has the system remained in service without modification since the last inspection?
Yes
No
Does Alarm Panel Show Normal?
Yes
No
Alarm Panel
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General System Comments:
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Fire Department Connection (FDC)
Chapter 13.8
Is the FDC plainly visible and accessible? 13.8.1 (1)
Yes
No
N/A
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Are the FDC caps/swivels/couplings free from damage and rotated freely? 13.8.1 (2)
Yes
No
N/A
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Are the FDC caps & plugs in place and undamaged? 13.8.1 (3)
Yes
No
N/A
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Are the FDC gaskets in place and in good condition? 13.8.1 (4)
Yes
No
N/A
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Is the FDC identification sign (s) in place and readable? 13.8.1 (5)
Yes
No
N/A
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Is the FDC check valve free from leaking? 13.8.1 (6)
Yes
No
N/A
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Is the automatic drain valve in place and operating properly? 13.8.1 (7)
Yes
No
N/A
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Fire department connection clapper(s) is in place and operating properly? 13.8.1 (8)
Yes
No
N/A
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Interior of the connection is inspected for obstructions? 13.8.1 (9)*
Yes
No
N/A
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Visible piping supplying the fire department connection is undamaged? 13.8.1 (10)
Yes
No
N/A
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FDC Comments:
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Backflow Preventer (BFP)
Chapter 13.7
System is in service and all isolation valves are in the normally open position and properly locked or electrically supervised? 13.7.1.2
Yes
No
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BFP valves exercised through full range of motion? 13.7.2.1
Yes
No
N/A
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BFP passed the full flow test at a minimum flow rate of the system demand? 13.7.2.1*
Yes
No
N/A
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BFP Comments:
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Wet System
General Valve Provisions - Chapter 13
Are all system valves protected from physical damage and accessible? 13.2.3*
Yes
No
N/A
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Valves are in the normal open or closed position? 13.3.2.2 (1)
Yes
No
N/A
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Valves are sealed, locked, or supervised? 13.3.2.2 (2)*
Yes
No
N/A
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Valves are accessible? 13.3.2.2 (3)*
Yes
No
N/A
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Post indicator valves (PIVs) are provided with correct wrenches? 13.3.2.2 (4)
Yes
No
N/A
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Valves are free from external leaks? 13.3.2.2 (5)
Yes
No
N/A
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Valves are provided with applicable identification? 13.3.2.2 (6)
Yes
No
N/A
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Valves were operated through their full range and returned to their normal position? 13.3.3.1
Yes
No
N/A
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Post indicator valves was opened until spring or torsion is felt in the rod, indicating that the rod has not become detached from the valve. 13.3.3.2*
Yes
No
N/A
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Hydraulic nameplate provided, securely attached, and readable? 5.2.5*
Yes
No
N/A
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General Information sign required by NFPA 13 provided, securely attached, and readable? 5.2.7 & 5.2.8*
Yes
No
N/A
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General Valve Comments:
Alarm Valves 13.4
The gauges indicate normal supply water pressure is being maintained? 13.4.1.1 (1)*
Yes
No
N/A
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The valves and trim are free of physical damage? 13.4.1.1 (2)
Yes
No
N/A
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All valves are in the appropriate open or closed position. 13.4.1.1 (3)
Yes
No
N/A
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The retarding chamber or alarm drains are not leaking? 13.4.1.1 (4)
Yes
No
N/A
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Alarm Valve Comments:
Guages 13.2.7
Guages are in good operating Order? 13.2.7.1*
Yes
No
N/A
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Guages monitoring water pressure are verified to confirm that normal water supply pressure is being maintained. 13.2.7.2
Yes
No
N/A
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Main Drain Test 13.2.5
Record initial static pressure: 13.2.5*
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Record residual pressure:
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Record static pressure:
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Seconds to return to initial static:
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Is flow Observed?
Yes
No
N/A
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Are results comparable to previous test? 13.2.5.3*
Yes
No
N/A
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Did water flow alarm operate? 13.2.6*
Yes
No
N/A
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Seconds to activation:
Main Drain Test Comments:
Supervisory Signal Devices 13.2.8
Did tamper switch operate? 13.2.8.2
Yes
No
N/A
Number of turns to activate:
Supervisory Signal Test Comments:
Sprinklers 5.2
All sprinklers are free from leaks? 5.2.1.1.1 (1)*
Yes
No
N/A
Sprinklers leaking
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All sprinklers are free from corrosion detrimental to sprinkler performance. 5.2.1.1.1 (2)
Yes
No
N/A
Sprinkler corrosion
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All sprinklers are free from physical damage? 5.2.1.1.1 (3)
Yes
No
N/A
Sprinkler damage
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All sprinklers are free from loss of fluid in the glass bulb heat-responsive element? 5.2.1.1.1 (4)
Yes
No
N/A
Sprinkler fluid loss
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All sprinklers are free from loading detrimental to sprinkler performance? 5.2.1.1.1 (5)
Yes
No
N/A
Sprinkler loading
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All sprinklers are free from paint other than that applied by the sprinkler manufacturer? 5.2.1.1.1 (6)
Yes
No
N/A
Sprinkler paint
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Are all sprinklers installed in their correct orientation? 5.2.1.1.2
Yes
No
N/A
Incorrect sprinkler orientation
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Are all escutcheons and coverplates installed? 5.2.1.1.5
Yes
No
N/A
Missing escutcheons
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Is the minimum clearance to storage being maintained? 5.2.1.2*
Yes
No
N/A
Incorrect clearance to sprinkler
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The correct number and type of sprinklers as required by 5.4.1.5*
Yes
No
N/A
Sprinklers in headbox
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A sprinkler wrench for each type of sprinkler as required by 5.4.1.5.5*
Yes
No
N/A
Sprinkler wrenches
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The list of spare sprinklers as required by 5.4.1.5.6*
Yes
No
N/A
Sprinkler list
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Have sprinklers and automatic spray nozzles used for protecting commercial-type cooking equipment and ventilating systems been replaced annually. 5.4.1.7*
Yes
No
N/A
Spare sprinkler heads
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Sprinklers protecting spray areas and mixing rooms in resin application areas installed with protective coverings are being protected against overspray residue so that they will operate in the event of fire? 5.4.1.8.1*
Yes
No
N/A
Spare sprinkler heads
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Check sprinkler manufactured dates per 5.3.1.1.1 - 5.3.1.3.1 to recommend testing and/or replacement
Enter Sprinkler Types
Rows
SIN
Mnfct
Orifice
Deflector Type
Other Info
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler Type
Sprinkler head comments:
Pipes & Fittings 5.2.2
Is the visible pipe in good condition with no external corrosion?*
Yes
No
N/A
Sprinkler Pipe Condition
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Is sprinkler piping free from external loads by materials either resting on the pipe or hung from the pipe?
Yes
No
N/A
Sprinkler Piping
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Is all sprinkler pipe protected from freezing? 4.1.2* - 4.1.2.3
Yes
No
N/A
Pipe exposed to freezing temperatures
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Pipe & Fittings Comments:
Hangers, Braces, and Supports 5.2.3
Are hangers free from damage, hanging loosly, or unattached? 5.2.3.1
Yes
No
N/A
Hangers
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Hangers, Braces, and Supports Comments:
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Dry System
13.4.5
Low-temperature alarm (if applicable) free from physical damage? 13.4.5.1.1.2
Yes
No
N/A
Low temp alarm
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Low-temperature alarm, if installed in valve enclosures, shall be tested annually at the beginning of the heating season? 13.4.5.2.7
Yes
No
N/A
Low temp alarm
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Dry valve auxiliary drain signs at the valve indicating the number and location of individual drains? 13.4.5.1.2
Yes
No
N/A
Auxiliary drain sign
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Dry valve is free from physical damage? 13.4.5.1.3 (1)
Yes
No
N/A
Dry Valve
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Dry valve trim valves are in the appropriate open or closed position?13.4.5.1.3 (2)
Yes
No
N/A
Auxiliary drain sign
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Dry valve intermediate chamber is free from leaking? 13.4.5.1.3 (3)
Yes
No
N/A
Auxiliary drain sign
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Priming water level tested? 13.4.5.2.1*
Yes
No
N/A
Auxiliary drain sign
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Dry pipe valve trip tested (during warm weather) 13.4.5.2.2*
Yes
No
N/A
Auxiliary drain sign
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During the years when full flow testing in accordance with 13.4.5.2.2.2 is not required, each dry pipe valve was trip tested with the control valve partially open? 13.4.5.2.2.3*
Yes
No
N/A
Auxiliary drain sign
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When dry system is refilled, the air supply restored normal air pressure within 30 minutes? 13.4.5.2.2.4*
Yes
No
N/A
Auxiliary drain sign
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Quick-opening devices, if provided, was tested? 13.4.5.2.4*
Yes
No
N/A
Auxiliary drain sign
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Dry pipe trip time: 13.4.5.2.5.2
Water delivery time: 13.4.5.2.5.2
Low air pressure alarm, if provided, tested in accordance with manufacturer's instructions? 13.4.5.2.6*
Yes
No
N/A
Auxiliary drain sign
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Automatic air pressure maintenance device, if installed, tested and passed? 13.4.5.2.8
Yes
No
N/A
Automatic air pressure maintenance device
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Auxiliary drains in dry pipe sprinkler systems was drained after each operation of the system, before the onset of freezing weather conditions, and thereafter as needed? 13.4.5.3.2*
Yes
No
N/A
Automatic air pressure maintenance device
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Pre-action System
13.4.3
Low-temperature alarm (if applicable) free from physical damage? 13.4.3.1.2
Yes
No
N/A
Low temp alarm
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Pre-action valve is free from physical damage? 13.4.3.1.3 (1)
Yes
No
N/A
Low temp alarm
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Pre-action valve trim valves are in the appropriate open or closed position? 13.4.3.1.3 (2)*
Yes
No
N/A
Pre-action Valve Trim
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Pre-action valve seat is free from leaking? 13.4.3.1.3 (3)*
Yes
No
N/A
Pre-action Valve Seat
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Pre-action valve electrical components are working? 13.4.3.1.3 (4)
Yes
No
N/A
Pre-action Electrical components
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Pre-action valve interior inspected? 13.4.3.1.4
Yes
No
N/A
Pre-action Valve Interior
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Pre-action valve auxiliary drain signs at the valve indicating the number and location of individual drains? 13.4.3.1.6
Yes
No
N/A
Pre-action draing signs
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Pre-action valve priming water level in supervised preaction system tested for compliance with manufacturer's instructions? 13.4.3.2.1*
Yes
No
N/A
Pre-action valve priming water level
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Pre-action trip time: 13.4.3.2.9*
Water delivery time: 13.4.3.2.9*
Low-pressure alarm, if installed, tested and passed? 13.4.3.2.11
Yes
No
N/A
Low-pressure alarm
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Automatic air pressure maintenance device, if installed, tested and passed? 13.4.3.2.12
Yes
No
N/A
Automatic air pressure maintenance device
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Guages monitoring air or nitrogen pressure are verified to confirm that normal air pressure is being maintained. 13.2.7.3
Yes
No
N/A
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The gauge on the quick-opening device, if provided, indicates the same pressure as the gauge on the system side of the dry pipe valve. 13.2.7.1.3.1
Yes
No
N/A
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For dry pipe or preaction systems protecting freezers with an air pressure gauge(s) on the air line(s) between the compressor and the dry pipe or preaction valve, the air pressure gauge near the compressor has been compared monthly to the pressure gauge above the dry pipe or preaction valve. 13.2.7.1.4*
Yes
No
N/A
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Deluge
13.4.4
Valve enclosures for deluge valves subject to freezing inspected to verify a minimum temperature of 40°F (4.0°C). 13.4.4.1.1
Yes
No
N/A
Valve Enclosure (Deluge)
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Low-temperature alarm (if applicable) free from physical damage? 13.4.4.1.2
Yes
No
N/A
Low Temp Alarm (Deluge)
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The deluge valve externally inspected to verify valve is free from damage? 13.4.4.1.3 (1)
Yes
No
N/A
Deluge Valve
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The deluge trim valves are in the appropriate open or closed position? 13.4.4.1.3(2)
Yes
No
N/A
Deluge Valve Trim
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The deluge valve seat is free from leaks? 13.4.4.1.3 (3)
Yes
No
N/A
Deluge Valve Seat
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The deluge valve electrical components are in service? 13.4.4.1.3 (4)
Yes
No
N/A
Deluge Valve Electrical Components
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The deluge valve interior inspected? 13.4.4.1.4
Yes
No
N/A
Deluge Valve Interior
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The deluge valve interior inspected? 13.4.4.1.4*
Yes
No
N/A
Deluge Valve Interior
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Air Compressor
13.10.2
Air Compressor is free from physical damage? 13.10.2.1 (1)
Yes
No
N/A
Air Compressor
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Power wiring to the air compressor is intact and free of physical damage? 13.10.2.1 (2)
Yes
No
N/A
Air Compressor
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Piping from the air compressor to the fire protection system is intact and free of physical damage? 13.10.2.1 (3)
Yes
No
N/A
The means of anchoring the air compressor to the structure or to the system piping is secure, tight, and free of physical damage? 13.10.2.1 (4)
Yes
No
N/A
Air compressors requiring oil have the required amount of oil in the oil reservoir? 13.10.2.1 (5)
Yes
No
N/A
Air compressor operates as intended on the proper drop of air pressure in the fire protection system? 13.10.3.1 (1)
Yes
No
N/A
Air compressor restores normal air pressure in the fire protection system in the required time frame? 13.10.3.1 (2)
Yes
No
N/A
Air compressor is free from overheating while running? 13.10.3.1 (3)
Yes
No
N/A
Air compressor restores normal air pressure in the fire protection system in the required time frame? 13.10.3.1 (2)
Yes
No
N/A
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Standpipe
6.1
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Hose Valve
13.6
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PRV
13.5
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Electric Fire Pump
8.1
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Diesel Fire Pump
8.1
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3-year
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5-year
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Any other Notes or Comments?
General Pictures
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Front of Tag
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