Loading...
72-12SysRecordInspectTestingForm_7.8.2g.doc North Commons 12-10-2021SYSTEM 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. 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) Inspection/Test Start Date/Time: 12/10/2021, 7:00 Inspection/Test Completion Date/Time: 12/10/2021 21:00 Supplemental Form(s) Attached: YES (yes/no) 1. PROPERTY INFORMATION Name of property: North Commons Address: 140 Orlander Dr, Northampton, Ma Description of property: Housing Name of property representative: Address: Phone: Fax: E-mail: 2. TESTING AND MONITORING INFORMATION Testing organization: Wel-Design Alarms Address: 2 Weston St. Wilbraham, MA 01095 Phone: 413-543-9090 Fax: N/A E-mail: Jack@wel-design.com Monitoring organization: Address: Phone: Fax: E-mail: 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: Notifier Model number: NFS2-640 4.2 Software and Firmware Firmware revision number: 27 4.3 System Power 4.3.1 Primary (Main) Power Nominal voltage: 120Volts Amps: 2.6 Location: Main Electric room Overcurrent protection type: Breaker Amps: 20 Disconnecting means location: PP21L-42 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 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) 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: S.L.A Location: inside FACP 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: Yes Time: 7:00 Building management Contact: YES Time: 7:00 Building occupants Contact: Yes Time: 7:00 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 Control unit Good Lamps/LEDs/LCDs Good Fuses Good Trouble signals Good Disconnect switches Good Ground-fault monitoring Good Supervision Good Local annunciator Good Remote annunciators N/A Remote power panels N/A 6.2 Secondary Power Description Visual Inspection Functional Test Comments Battery condition Good Load voltage Good Discharge test Good Charger test Good Remote panel batteries Good SYSTEM RECORD OF INSPECTION AND TESTING (continued) 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) 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 Alarm signal N/A Alarm restoration N/a Trouble signal N/A Trouble restoration N/A Supervisory signal N/A Supervisory restoration N/A 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal 12:00 Good Alarm restoration 12:00 Good Trouble signal 12:00 Good Trouble restoration 12:00 Good Supervisory signal 12:00 Good Supervisory restoration 12:00 Good SYSTEM RECORD OF INSPECTION AND TESTING (continued) 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) 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: Waiting On Fire Dept Testing Time: 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14. Signed: Printed name: Richard Godbout Date: 12/10/2021 Organization: Wel-Design Alarms, INC. Title: Technician Phone: 413-543-9090 Qualifications (refer to 10.5.3): 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE We Did not test the elevator recall. The Elevator company was not on site. 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: