12-4 Technology Drive, East Setauket, NY 11733
(631) 689-6869 (631) 689-6866
[email protected] facebook
System Offline Operator name
Alarm Panel
TYPE ID SIZE LOCATION IN SITERISER 1
RISER 2
SIGNATURES
System Online
DRY RISERS
Total Number of Dry Risers
RISER 3
RISER 4
RISER 5
RISER 6
RISER 7
RISER 8
RISER 9
Inspector Printed Inspector - Signature Date Completed
I state the information on this form is correct at the time and place of my inspection, and all the equipment tested at this time was left in operational condition upon completion of this inspection except as noted.
Except as noted, the building occupancy and hazard classifications have not changed since last inspection. After this inspection, the system has been restored to normal and all panels are clear. All deficiencies and immediate actions have been explained to me and I have been informed of all necessary actions.
Authorized Representative Printed Authorized Representative Signature Date Completed
DRY ANNUAL INSPECTION Customer
Customer W.O.#
Technician Name
Date of Inspection
Building Name
Building Street
Building City/State/Zip
Building ID#
RISER 10
DRY VALVE INSPECTIONValves accessible and free from physical damage?
No leakage from intermediate chamber?
Low Air pressure signal passed test?
Gauges on dry, preaction, & deluge systems in good condition?
AIR PRESSURE
Yes No N/ATrim Valves in appropriate position & free from leaks?
Priming Water level correct?
Hydraulic nameplate, if provided, securely attached?
Quick opening devices passed Test?
Yes No N/A
FIRE DEPARTMENT CONNECTION
Total Number of FDC's
Visible and accessible?
Plugs or Caps in place and undamaged?
Caps painted as per AHJ code?
Identification signs(s) in place?
Ball Drip Valve in place and operating properly?
Couplings & swivels not damage and rotate smoothly?
Gaskets in place in good condition?
Check valve is not leaking?
Interior free of obstructions (if caps are not in place)?
Yes No N/A Yes No N/A
WATER PRESSURE
Job #
DRY VALVE TRIP TEST
MODELLOCATIONTYPE
DRY VALVE
SIZE MAKEWATER
PRESSUREAIR
PRESSURE
TRIPPINGAIR
PRESSURETRIP TIME ALARM
ACTUATE
PSI
PSI
SPRINKLERSSpare sprinklers - proper number and type, wrench?
Free of corrosion, foreign material, or paint?
Installed in proper orientation?
Free from obstructions to spray patterns?
Free from leaks and physical damaged?
Liquid in all glass bulb sprinklers?
Yes No N/APIPE Yes No N/A
In good visual condition?
No external corrosion/loads?
Free of mechanical damage and leaks?
Properly aligned?
Visible pipe hangers and seismic braces not damaged or loose?
NYC only -- Pipes / valves painted per code?
COLD WEATHER CHECK
Interior of pipe in preaction and dry pipe systems which passes through freezers free of ice blockage?
Low temperature alarms in dry pipe, preaction and deluge valve enclosures functioning?
Low points drained in dry pipe during and after trip?
Yes No N/A
CONTROL VALVE 1
CONTROL VALVE 2
CONTROL VALVE 3
CONTROL VALVE 4
CONTROL VALVE 5
CONTROL VALVE 6
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
PSI
3-YEAR ONLY
WATER DELIVERY TIMEMIN SEC
MAIN DRAIN VALVE 1
MAIN DRAIN VALVE 2
MAIN DRAIN VALVE 3
MAIN DRAIN VALVE 4
MAIN DRAIN VALVE 5
MAIN DRAIN VALVE 6
MAIN DRAIN VALVE 7
MAIN DRAIN VALVE 8
MAIN DRAIN VALVE 9
MAIN DRAIN VALVE 10
MAIN DRAIN VALVES
LOCATION TYPE RISER# SIZE SIGNAGEPRESSURE (PSI)
RESIDUAL STATICINITIAL
RESULTSCOMPARABLE TO PRIOR TEST
DRAINSPROPERLY
Results comparable to previous test?
INSPECTOR'S TEST VALVE 1
INSPECTOR'S TEST VALVE 2
INSPECTOR'S TEST VALVE 3
INSPECTOR'S TEST VALVE 4
INSPECTOR'S TEST VALVE 5
INSPECTOR'S TEST VALVE 6
INSPECTOR'S TEST VALVE 7
INSPECTOR'S TEST VALVE 8
INSPECTOR'S TEST VALVE 9
INSPECTOR'S TEST VALVE 10
INSPECTOR'S FLOW TEST VALVES
TYPE LOCATION INSITE RISER# SIZE EASILY
ACCESSIBLE
AUDIBLEALARM
REPORTEDTIME TOALARM
SMOOTH ORIFICE
WATERFLOWDEVICES
PASS TESTSIGNAGE
TYPE LOCATION RISER # SIZE INSPECTION
OPENLEAKAGE ACCESSIBLE SIGNSSECURED
CONTROL VALVES
CONTROL VALVE 1
CONTROL VALVE 2
CONTROL VALVE 3
CONTROL VALVE 4
CONTROL VALVE 5
CONTROL VALVE 6
CONTROL VALVE 7
CONTROL VALVE 8
CONTROL VALVE 9
CONTROL VALVE 10
CONTROL VALVE 11
CONTROL VALVE 12
CONTROL VALVE 13
CONTROL VALVE 14
CONTROL VALVE 15
CONTROL VALVE 16
CONTROL VALVE 17
CONTROL VALVE 18
CONTROL VALVE 19
CONTROL VALVE 20
12-4 Technology Drive, East Setauket, NY 11733
(631) 689-6869 (631) 689-6866
[email protected] facebook
System Offline Operator name
Alarm Panel System Online
RISER
Total Number of Wet Risers
WET ANNUAL INSPECTION Customer
Customer W.O.#
Technician Name
Date of Inspection
SIGNATURESInspector Printed Inspector - Signature Date Completed
I state the information on this form is correct at the time and place of my inspection, and all the equipment tested at this time was left in operational condition upon completion of this inspection except as noted.
Authorized Representative Printed Authorized Representative Signature Date Completed
Except as noted, the building occupancy and hazard classifications have not changed since last inspection. After this inspection, the system has been restored to normal and all panels are clear. All deficiencies and immediate actions have been explained to me and I have been informed of all necessary actions.
Building Name
Building Street
Building City/State/Zip
Building ID#
FIRE DEPARTMENT CONNECTIONTotal Number of FDC's
Visible and accessible?
Plugs or Caps in place and undamaged?
Caps painted as per AHJ code?
Identification signs(s) in place?
Ball Drip Valve in place and operating properly?
Couplings and swivels not damage and rotate smoothly?
Gaskets in place in good condition?
Check valve is not leaking?
Interior free of obstructions (if caps are not in place)?
Yes No N/A
TYPE ID SIZE LOCATION PSI
RISER 1
RISER 2
RISER 3
RISER 4
RISER 5
RISER 6
RISER 7
RISER 8
RISER 9
RISER 10
WATER BASED SYSTEM INSPECTION
Are there landlord/access issues requiring visual only?
Gauges on wet pipe system in good condition and
showing normal water supply pressure?
Alarm devices accessible?
Retard chamber/alarm drains OK?
Alarm devices free from physical damage?
Is the Audible alarm device working properly?
Hydraulic nameplate, if provided, securely attached to
riser and legible?
Valve supervisory switches indicate movement ?
Yes No N/A
Job #
PIPE
In good visual condition?
No external corrosion/loads?
Free of mechanical damage and leaks?
Properly aligned?
Visible pipe hangers and seismic braces not damaged or loose?
NYC only -- Pipes / valves painted per code?
SPRINKLERS
Spare sprinklers - proper number and type, wrench?
Free of corrosion, foreign material, or paint?
Installed in proper orientation?
Free from obstructions to spray patterns?
Free from leaks and physical damaged?
Liquid in all glass bulb sprinklers?
Yes No N/A Yes No N/A
MAIN DRAIN VALVE 1
MAIN DRAIN VALVE 2
MAIN DRAIN VALVE 3
MAIN DRAIN VALVE 4
MAIN DRAIN VALVE 5
MAIN DRAIN VALVE 6
MAIN DRAIN VALVE 7
MAIN DRAIN VALVE 8
MAIN DRAIN VALVE 9
MAIN DRAIN VALVE 10
MAIN DRAIN VALVES
LOCATION TYPE RISER# SIZE SIGNAGEPRESSURE (PSI)
RESIDUAL STATICINITIAL
RESULTSCOMPARABLE TO PRIOR TEST
DRAINSPROPERLY
INSPECTOR'S TEST VALVE 1
INSPECTOR'S TEST VALVE 2
INSPECTOR'S TEST VALVE 3
INSPECTOR'S TEST VALVE 4
INSPECTOR'S TEST VALVE 5
INSPECTOR'S TEST VALVE 6
INSPECTOR'S TEST VALVE 7
INSPECTOR'S TEST VALVE 8
INSPECTOR'S TEST VALVE 9
INSPECTOR'S TEST VALVE 10
INSPECTOR'S FLOW TEST VALVES
TYPE LOCATION INSITE RISER# SIZE EASILY
ACCESSIBLE
AUDIBLEALARM
REPORTEDTIME TOALARM
SMOOTH ORIFICE
WATERFLOWDEVICES
PASS TESTSIGNAGE
TYPE LOCATION RISER # SIZE INSPECTION
OPENLEAKAGE ACCESSIBLE SIGNSSECURED
CONTROL VALVES
CONTROL VALVE 1
CONTROL VALVE 2
CONTROL VALVE 3
CONTROL VALVE 4
CONTROL VALVE 5
CONTROL VALVE 6
CONTROL VALVE 7
CONTROL VALVE 8
CONTROL VALVE 9
CONTROL VALVE 10
CONTROL VALVE 11
CONTROL VALVE 12
CONTROL VALVE 13
CONTROL VALVE 14
CONTROL VALVE 15
CONTROL VALVE 16
CONTROL VALVE 17
CONTROL VALVE 18
CONTROL VALVE 19
CONTROL VALVE 20
CONTROL VALVE 21
CONTROL VALVE 22
CONTROL VALVE 23
CONTROL VALVE 24
CONTROL VALVE 25
CONTROL VALVE 26
CONTROL VALVE 27
CONTROL VALVE 28
CONTROL VALVE 29
CONTROL VALVE 30
EXERCISED # OF TURNS LUBRICATED
MAINTENANCE TEST
TAMPER SIGNAL TIME TO ALARM
ANNUAL SECTION ONLY
12-4 Technology Drive, East Setauket, NY 11733
(631) 689-6866(631) 689-6869
[email protected] facebook
ANNUAL CONTROL VALVE INSPECTION
CONTROL VALVE 1
CONTROL VALVE 2
CONTROL VALVE 3
CONTROL VALVE 4
CONTROL VALVE 5
CONTROL VALVE 6
CONTROL VALVE 7
CONTROL VALVE 8
CONTROL VALVE 9
CONTROL VALVE 10
CONTROL VALVE #
CONTROL VALVE 11
CONTROL VALVE 12
CONTROL VALVE 13
CONTROL VALVE 14
CONTROL VALVE 15
CONTROL VALVE 16
CONTROL VALVE 17
CONTROL VALVE 18
CONTROL VALVE 19
CONTROL VALVE 20
CONTROL VALVE 21
CONTROL VALVE 22
CONTROL VALVE 23
CONTROL VALVE 24
CONTROL VALVE 25
CONTROL VALVE 26
CONTROL VALVE 27
CONTROL VALVE 28
CONTROL VALVE 29
CONTROL VALVE 30
CONTROL VALVE 31
CONTROL VALVE 32
CONTROL VALVE 33
CONTROL VALVE 34
CONTROL VALVE 35