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FIRE ALARM SYSTEM RECORD OF COMPLETION

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FIRE ALARM SYSTEM RECORD OF COMPLETION

FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION

    To be completed by the system installation contractor at the time of system acceptance and approval.

    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.

    1. PROPERTY INFORMATION

     Name of property:

     Address:

     Description of property:

     Occupancy type:

     Name of property representative:

     Address:

     Phone: Fax: E-mail:

     Authority having jurisdiction over this property:

     Phone: Fax: E-mail:

    2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION

     Installation contractor for this equipment:

     Address:

     License or certification number:

     Phone: Fax: E-mail:

     Service organization for this equipment:

     Address:

     License or certification number:

     Phone: Fax: E-mail:

     A contract for test and inspection in accordance with NFPA standards is in effect as of:

     Contracted testing company:

     Address:

     Phone: Fax: E-mail:

     Contract expires: Contract number: Frequency of routine inspections:

    3. DESCRIPTION OF SYSTEM OR SERVICE

     Fire alarm system (nonvoice)

     Fire alarm with in-building fire emergency voice alarm communication system (EVACS)

     Mass notification system (MNS)

     Combination system, with the following components:

     Fire alarm EVACS MNS Two-way, in-building, emergency communication system

     Other (specify):

    NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12)

    Copyright ? 2009 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.

3. DESCRIPTION OF SYSTEM OR SERVICE (continued)

     Additional description of system(s): NFPA 72 edition:

    3.1 Control Unit

     Manufacturer: Model number: 3.2 Mass Notification System This system does not incorporate an MNS

    3.2.1 System Type:

     In-building MNScombination

     In-building MNSstand-alone Wide-area MNS Distributed recipient MNS

     Other (specify):

    3.2.2 System Features:

     Combination fire alarm/MNS MNS autonomous control unit Wide-area MNS to regional national

     alerting interface

     Local operating console (LOC) Direct recipient MNS (DRMNS) Wide-area MNS to DRMNS interface

     Wide-area MNS to high-power speaker array (HPSA) interface In-building MNS to wide-area MNS interface

     Other (specify):

    3.3 System Documentation

     An owner’s manual, a copy of the manufacturer’s instructions, a written sequence of operation, and a copy of

     the numbered record drawings are stored on site. Location:

    3.4 System Software This system does not have alterable site-specific software.

     Operating system (executive) software revision level:

     Site-specific software revision date: Revision completed by:

     A copy of the site-specific software is stored on site. Location:

    3.5 Off-Premises Signal Transmission This system does not have off-premises transmission.

    Name of organization receiving alarm signals with phone numbers:

     Alarm: Phone:

     Supervisory: Phone:

     Trouble: Phone:

     Entity to which alarms are retransmitted: Phone:

     Method of retransmission:

     If Chapter 26, specify the means of transmission from the protected premises to the supervising station:

     If Chapter 27, specify the type of auxiliary alarm system: Local energy Shunt Wired Wireless

    NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12)

    Copyright ? 2009 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.

4. CIRCUITS AND PATHWAYS

    4.1 Signaling Line Pathways

    4.1.1 Pathways Class Designations and Survivability

     Pathways class: Survivability level: Quantity:

     (See NFPA 72, Sections 12.3 and 12.4)

    4.1.2 Pathways Utilizing Two or More Media

     Quantity: Description: 4.1.3 Device Power Pathways

     No separate power pathways from the signaling line pathway

     Power pathways are separate but of the same pathway classification as the signaling line pathway

     Power pathways are separate and different classification from the signaling line pathway

    4.1.4 Isolation Modules

     Quantity:

    4.2 Alarm Initiating Device Pathways

    4.2.1 Pathways Class Designations and Survivability

     Pathways class: Survivability level: Quantity:

    (See NFPA 72, Sections 12.3 and 12.4)

    4.2.2 Pathways Utilizing Two or More Media

     Quantity: Description: 4.2.3 Device Power Pathways

     No separate power pathways from the initiating device pathway

     Power pathways are separate but of the same pathway classification as the initiating device pathway

     Power pathways are separate and different classification from the initiating device pathway

    4.3 Non-Voice Audible System Pathways

    4.3.1 Pathways Class Designations and Survivability

     Pathways class: Survivability level: Quantity:

    (See NFPA 72, Sections 12.3 and 12.4)

    4.3.2 Pathways Utilizing Two or More Media

     Quantity: Description: 4.3.3 Device Power Pathways

     No separate power pathways from the notification appliance pathway

     Power pathways are separate but of the same pathway classification as the notification appliance pathway

     Power pathways are separate and different classification from the notification appliance pathway

    NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12)

Copyright ? 2009 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.

5. ALARM INITIATING DEVICES

    5.1 Manual Initiating Devices

    5.1.1 Manual Fire Alarm Boxes This system does not have manual fire alarm boxes.

     Type and number of devices: Addressable: Conventional: Coded: Transmitter:

     Other (specify):

    5.1.2 Other Alarm Boxes This system does not have other alarm boxes.

     Description:

     Type and number of devices: Addressable: Conventional: Coded: Transmitter:

     Other (specify):

    5.2 Automatic Initiating Devices

    5.2.1 Smoke Detectors This system does not have smoke detectors.

     Type and number of devices: Addressable: Conventional:

     Other (specify):

    Type of coverage: Complete area Partial area Nonrequired partial area

     Other (specify):

     Type of smoke detector sensing technology: Ionization Photoelectric Multicriteria Aspirating Beam

     Other (specify):

    5.2.2 Duct Smoke Detectors This system does not have alarm-causing duct smoke detectors.

     Type and number of devices: Addressable: Conventional:

     Other (specify):

     Type of coverage:

    Type of smoke detector sensing technology: Ionization Photoelectric Aspirating Beam 5.2.3 Radiant Energy (Flame) Detectors This system does not have radiant energy detectors.

     Type and number of devices: Addressable: Conventional:

     Other (specify):

     Type of coverage:

    5.2.4 Gas Detectors This system does not have gas detectors.

     Type of detector(s):

     Number of devices: Addressable: Conventional:

     Type of coverage:

    5.2.5 Heat Detectors This system does not have heat detectors.

     Type and number of devices: Addressable: Conventional:

    Type of coverage: Complete area Partial area Nonrequired partial area Linear Spot Type of heat detector sensing technology: Fixed temperature Rate-of-rise Rate compensated

    NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12)

    Copyright ? 2009 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.

5. ALARM INITIATING DEVICES (continued)

    5.2.6 Addressable Monitoring Modules This system does not have monitoring modules.

     Number of devices:

    5.2.7 Waterflow Alarm Devices This system does not have waterflow alarm devices.

     Type and number of devices: Addressable: Conventional: Coded: Transmitter: 5.2.8 Alarm Verification This system does not incorporate alarm verification.

     Number of devices subject to alarm verification: Alarm verification set for: seconds 5.2.9 Presignal This system does not incorporate pre-signal.

     Number of devices subject to presignal:

     Describe presignal functions:

    5.2.10 Positive Alarm Sequence (PAS) This system does not incorporate PAS.

     Describe PAS:

    5.2.11 Other Initiating Devices This system does not have other initiating devices.

     Describe:

    6. SUPERVISORY SIGNAL-INITIATING DEVICES

    6.1 Sprinkler System Supervisory Devices This system does not have sprinkler supervisory devices.

     Type and number of devices: Addressable: Conventional: Coded: Transmitter:

     Other (specify):

    6.2 Fire Pump Description and Supervisory Devices This system does not have a fire pump. Type fire pump: Electric pump Engine

     Type and number of devices: Addressable: Conventional: Coded: Transmitter:

     Other (specify):

    6.2.1 Fire Pump Functions Supervised

     Power Running Phase reversal Selector switch not in auto Engine or control panel trouble Low fuel

     Other (specify):

    6.3 Duct Smoke Detectors (DSDs) This system does not have DSDs causing supervisory signals.

     Type and number of devices: Addressable: Conventional:

     Other (specify):

     Type of coverage:

    Type of smoke detector sensing technology: Ionization Photoelectric Aspirating Beam 6.4 Other Supervisory Devices This system does not have other supervisory devices.

     Describe:

    NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12)

Copyright ? 2009 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.

7. MONITORED SYSTEMS

    7.1 Engine-Driven Generator This system does not have a generator. 7.1.1 Generator Functions Supervised

     Engine or control panel trouble Generator running Selector switch not in auto Low fuel

     Other (specify):

    7.2 Special Hazard Suppression Systems This system does not monitor special hazard systems.

     Description of special hazard system(s):

    7.3 Other Monitoring Systems This system does not monitor other systems.

     Description of special hazard system(s):

    8. ANNUNCIATORS This system does not have annunciators.

    8.1 Location and Description of Annunciators

     Location 1:

     Location 2:

     Location 3:

    9. ALARM NOTIFICATION APPLIANCES

    9.1 In-Building Fire Emergency Voice Alarm Communication System This system does not have an EVACS.

     Number of single voice alarm channels: Number of multiple voice alarm channels:

     Number of speakers: Number of speaker circuits:

     Location of amplification and sound-processing equipment:

     Location of paging microphone stations:

     Location 1:

     Location 2:

     Location 3:

    9.2 Nonvoice Notification Appliances This system does not have nonvoice notification appliances.

     Horns: With visible: Bells: With visible:

     Chimes: With visible:

     Visible only: Other (describe):

    9.3 Notification Appliance Power Extender Panels This system does not have power extender panels.

     Quantity:

     Locations:

    NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12)

Copyright ? 2009 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.

10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS This system does not have an MNS.

    10.1 MNS Local Operating Consoles

     Location 1:

     Location 2:

     Location 3:

    10.2 High-Power Speaker Arrays

     Number of HPSA speaker initiation zones:

     Location 1:

     Location 2:

     Location 3:

    10.3 Mass Notification Devices

     Combination fire alarm/MNS visible appliances: MNS-only visible appliances:

     Textual signs: Other (describe):

     Supervision class:

    10.3.1 Special Hazard Notification

     This system does not have special suppression predischarge notification.

     MNS systems DO NOT override notification appliances required to provide special suppression

     predischarge notification.

    11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS

    11.1 Telephone System This system does not have a two-way telephone system.

     Number of telephone jacks installed: Number of warden stations installed:

     Number of telephone handsets stored on site:

    Type of telephone system installed: Electrically powered Sound powered

     11.2 Two-Way Radio Communications Enhancement System

     This system does not have a two-way radio communications enhancement system.

     Percentage of area covered by two-way radio service: Critical areas: % General building areas: %

     Amplification component locations:

     Inbound signal strength: dBm Outbound signal strength: dBm

     Donor antenna isolation is: dB above the signal booster gain

     Radio frequencies covered:

     Radio system monitor panel location:

    NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12)

    Copyright ? 2009 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.

11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued)

    11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems

     This system does not have an area of refuge (area of rescue assistance) emergency communications system.

     Number of stations: Location of central control point:

     Days and hours when central control point is attended:

     Location of alternate control point:

     Days and hours when alternate control point is attended:

    11.4 Elevator Emergency Communications Systems

     This system does not have an elevator emergency communications system.

     Number of elevators with stations: Location of central control point:

     Days and hours when central control point is attended:

     Location of alternate control point:

     Days and hours when alternate control point is attended:

    11.5 Other Two-Way Communication Systems

     Describe:

    12. CONTROL FUNCTIONS

    This system activates the following control fuctions:

     Hold-open door releasing devices Smoke management HVAC shutdown F/S dampers

     Door unlocking Elevator recall Fuel source shutdown Extinguishing agent release

     Elevator shunt trip Mass notification system override of fire alarm notification appliances

     Other (specify):

    12.1 Addressable Control Modules This system does not have control modules.

     Number of devices:

     Other (specify):

    13. SYSTEM POWER

    13.1 Control Unit

    13.1.1 Primary Power

     Input voltage of control panel: Control panel amps:

     Overcurrent protection: Type: Amps:

     Location (of primary supply panel board):

     Disconnecting means location:

    13.1.2 Engine-Driven Generator This system does not have a generator.

     Location of generator:

     Location of fuel storage: Type of fuel:

    NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12)

    Copyright ? 2009 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.

13. SYSTEM POWER (continued)

    13.1.3 Uninterruptible Power System This system does not have a UPS.

     Equipment powered by a UPS system:

     Location of UPS system:

    Calculated capacity of UPS batteries to drive the system components connected to it:

     In standby mode (hours): In alarm mode (minutes): 13.1.4 Batteries

     Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system:

     In standby mode (hours): In alarm mode (minutes):

     Batteries are marked with date of manufacture Battery calculations are attached

    13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System

     This system does not have an EVACS or MNS system.

    13.2.1 Primary Power

     Input voltage of EVACS or MNS panel: EVACS or MNS panel amps:

     Overcurrent protection: Type: Amps:

     Location (of primary supply panel board):

     Disconnecting means location:

    13.2.2 Engine-Driven Generator This system does not have a generator.

     Location of generator:

     Location of fuel storage: Type of fuel: 13.2.3 Uninterruptible Power System This system does not have a UPS.

     Equipment powered by a UPS system:

     Location of UPS system:

    Calculated capacity of UPS batteries to drive the system components connected to it:

     In standby mode (hours): In alarm mode (minutes): 13.2.4 Batteries

     Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system:

     In standby mode (hours): In alarm mode (minutes):

     Batteries are marked with date of manufacture Battery calculations are attached

    NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12)

    Copyright ? 2009 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.

13. SYSTEM POWER (continued)

    13.3 Notification Appliance Power Extender Panels This system does not have power extender panels. 13.3.1 Primary Power

     Input voltage of power extender panel(s): Power extender panel amps:

     Overcurrent protection: Type: Amps:

     Location (of primary supply panel board):

     Disconnecting means location:

    13.3.2 Engine-Driven Generator This system does not have a generator.

     Location of generator:

     Location of fuel storage: Type of fuel: 13.3.3 Uninterruptible Power System This system does not have a UPS.

     Equipment powered by a UPS system:

     Location of UPS system:

    Calculated capacity of UPS batteries to drive the system components connected to it:

     In standby mode (hours): In alarm mode (minutes): 13.3.4 Batteries

     Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system:

     In standby mode (hours): In alarm mode (minutes):

     Batteries are marked with date of manufacture Battery calculations are attached

    14. RECORD OF SYSTEM INSTALLATION

     Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper

     branching, but before confucting operational acceptance tests.

     This is a: New system Modification to an existing system Permit number:

     The system has been installed in accordance with the following requirements: (Note any or all that apply.)

     NFPA 72, Edition:

     NFPA 70, National Electrical Code, Article 760, Edition:

     Manufacturer’s published instructions

     Other (specify):

     System deviations from referenced NFPA standards:

     Signed: Printed name: Date:

     Organization: Title: Phone:

    NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12)

    Copyright ? 2009 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.

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