INSPECfiON AND TESTING FORM PROPERTY NAME (USER) APPROVING AGENCY. Contact: Telephone:

Transcription

1 ... SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECfiON AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: _ TIME: 1: Name: _Si_em_en_s_B_u_ild_in_g._T_ec_hn_o_log ie_s Name: Kctcs Glasgow Building "" Address: 27 Stanley Gault Address: 129 State Street Louisville, Kentucky 423 Glasgow Kentucky Reresentative: Martin Hinkle Owner Contact: Johnnv Hatcher License No.: -FA-R Telehone: {27) 5~ 3668 Telehone: (52} MONITORING ENTITY Contact: Simle Monitoring Telehone: (888) Monitoring Account Ref. No.: _. APPROVING AGENCY Contact: Telehone: TYPE TRANSMISSION McCufloh Multile Ii'.'.! igital (SK-514) Reverse Priority RF Shunt Parallel Phone None SERVICE Weekly Monthly Quarterly Semiannually Ii'.'.! Annually Other (Secify) Other (Secify) Control Unit Manufacturer: Si~m=~ le ~ ModelNumber:,_4~1~' Circuit Styles: Class B Location : (Main Foyer) Number of Circuits: 5 Communicator: Net To FACP Software Rev.: Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANTITY 14 2 ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 Style 4 Photo etector Manual Pull Station Alarm Verification Feature is isabled Enabled X (NFPA Insection and Testing, 1 of 6)

2 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION CIRCUIT STYLE...;;; 2... Style Y Hom/Strobes -----'7- Style Y Stebe Number of alarm notification aliance circuits:...;.. 4 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity 1 Style(s)... stv..._l e..., 4 SYSTEM POWER SUPPLIES (a) (b) Primary (Main): Nominal Voltage -=12=1=.9' Ams _2~;... Overcurrent Protection: Tye Breaker Ams _2=' Location (of Primary Suly Panel Board):...,..., ci,...,. rc_u_it_#_2 isconnecting Means Location: _..;:;; Cl""' as;:;;::s;;...; roo= m'-"'l""'o""' l Secondary (Standby): Storage Battery: Am-Hour Rating -=1' Calculated Caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell Nickel-cadmium ~ Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Artide Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

3 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIRCATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING YES No WHO Iii Oerator Iii All Iii Johnny Hatcher a TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS Ii::! Iii Iii Ii::! Ii::! Iii Ii::! Iii Ii::! Iii Ii::! Iii Iii SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators Ii::! CJ NOTIRCATION APPUANCES Audible Visual Seakers Voice Clarity Ii::! Iii Ii::! Iii a INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. FACTORY MEASURE LOCATION & 5/N EVICE TYPE CHECK TEST SETTING SETTING Front Fo:r:er Above FACP Photo etector Hall b:r: Front Entrance Photo etector Front Entrance Manual Pull Station Oassroom 11 Photo etector Mens Restroom Photo etector Room 17 1 Custodal Photo etector Womens Restroom Photo etector Hall I'. Restrooms Photo etector Oassroom 14 Photo etector aassroom 12 Photo etector aassroom 12 Photo etector aassroom 13 Photo etector aassroom 13 Photo etector Hall Center Photo etector PASS FAIL (NFPA Insection and Testing, 3 of 6)

4 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & S/N Hall Rear Rear Hall Eit EVICE TYPE Photo etector Manual Pull Station CHECK TEST FACTORY SETTING MEASURE SETTING PASS FAIL Comments: All Initiating evices worked Proerly. * "" Manually set the 'Pass' state (NFPA Insection and Testing, 4 of 6)

5 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO FAILURES EVICE LIST LOCATION &S/N EVICETVPE PASS F.ut. Hall Front Entrance Hom/Strobe aassroom 11 Strobe Mens Restroom Strobe Womens Restroom Strobe aassroom 14 Strobe aassroom 12 Strobe Oassroom 13 Strobe aassroom 13 Strobe Hall Rear Eit Hom/Strobe Comments: All Hom/Strobes Worked Proerly. (NFPA Insection and Testing, 5 of 6)

6 SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT FuNcnONAL Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) Call-in Signal System Performance EVICE INTERFACE EQUIPMENT OPERATION (Secify) (Secify) (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) SIMULATE OPERATION Secial Procedures: N ne Comments: N n SUPERVISING STATION MONITORING YES No TIME Alarm Signal!!'.! Alarm Restoration!!'.! Suervisory Signal Suervisory Restoration Trouble Signal!!'.! Trouble Restoral!!'.! NOTIFICATIONS THAT TESTING IS COMPLETE Yes No WHO Monitoring Agency!!'.! Oerator Building Occuants!!'.! All Building Management!!'.! Johnny Hathcher other (Secify) CoMMENTS TIME The following did not oerate correctly: The System Tested Good Batteries need to be relaced System restored to normal oeration: ate: _ Time: 1: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector Martin Hinkle ate: _ Time: 1: Signature: Name of Owner or Reresentative: _Johnny Hatcher : ate: Time: - -=1=: Signature: (NFPA Insection and Testing, 6 of 6)

7 ... SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: TIME: 11: Name: Siemens Building Technologies Name: Kctcs Glasgg,_w, Bldg. "E" Address: 27 Stanley Gault Suite 135 Louisville Address: 129 State Street Kentucky 4223 Glasgow Kentuck.y Reresentative:...;..;M=arti= =n..;..h=ln=k""'le Owner Contact: Johnny Hatcher License No.: _F;..;.A..;;..R.;..;-1;;;...4"""5a.;;;... Telehone: {27) Telehone: (52) MONITORING ENTITY APPROVING AGENCY Contact: Contact: Telehone: (877) Telehone: Monitoring Account Ref. No.: _.;;;;2;;.:9;..::.6.::..:2;;.:1"'"7 TYPE TRANSMISSION O McCulloh o Multile igital Reverse Priority ORF O Shunt Parallel Phone o None SERVICE Weekly Monthly o Quarterly Semiannually Annually Other (Secify) Other (Secify) Control Unit Manufacturer: :_: N=oti="fi=e.:... r :...:,; NFW :...;..;.;5;;.:' Model Number: :_: N.:... FW:...:...;:-5'--., Circuit Styles: Class B (15t.FI. Hallway) Number of Circuits: 8 Software Rev.: Last ate System Had Any Service Performed: ----, Last ate that Any Software or Configuration Was Revised: QUANTITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 Style 4 Style 4 Ionization etector Manual Pull Station Heat etector Alarm Verification Feature Is isabled Enabled X (NFPA Insection and Testing, 1 of 6)

8 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTTIY ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION CIRCUIT STYLE -----=a:.. Style Y Four Hom/Strobes and Two Strobes Number of alarm notification aliance circuits: Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity O Style(s) SYSTEM POWER SUPPUES (a) (b) Primary (Main): Nominal Voltage -=12:a.;::1:.:...4"' Ams -=2= vercurrent Protection: Tye Breaker Ams -=2= Location (of Primary Suly Panel Board): isconnecting Means Location: Secondary (Standby): Storage Battery: Am Hour Rating _7. calculated caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell o Nickel-cadmium ~ Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article 71. Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

9 SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments YES PRIOR To ANY TESTING No WHO Admin Johnny Hatcher TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators NOTIFICATION APPUANCES Audible Visual Seakers Voice Clarity c INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVf Bl!l!N TESTE ARE IN,CLUE HERE. FUNC11NAL FACTORY MEASURE LOCATION & 5/ N EVICE TYPE CHECK TEST SETTING SETTING Marn En21 oor Manual Pull Station Rear Eit oor Manual Pull Station Above FACP Ionization etector Micro LAB Heat etector IT Room Heat etector Room 15 Ionization etector Room 17 Ionization etector Mechanical Rm. Heat etector PASS FAIL (NFPA Insection and Testing, 3 of 6)

10 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & 5/N MCETYPE CHECK TEST FACTORY SETTING MEASURE SETTING PASS FAIL * = Manually set the 'Pass' state Comments: (NFPA Insection and Testing, 4 of 6)

11 . '.. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & 5/N ~~ in Entry Hom/Strobe. Hall by FACP Hom/Strobe Restroom Strobe. Hall Hom/Strobe Room 15 Hom/Strobe Room 17 Strobe AUIO FAILURES EVICE UST EVICE TYPE PASS Fm Comments: All Hom/Strobes worked Proerly. (NFPA Insection and Testing, 5 of 6)

12 '. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) call-in Signal System Performance INTERFACE EQUIPMENT (Secify) (Secify) (Secify) EVICE OPERATION SIMULATE OPERATION SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) Secial Procedures:...:.N=o=n=e Commen~:~N=n~e ~ SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING JS COMPLETE YES No WHO TIME Monitoring Agency Oeerator Building Occuan~ All Building Management Johnnl Hatcher Other (Secify) The following did not oerate correctly: System restored to normal oeration: ate: _ Time: 11: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector: Martin Hinkle ate: Time:...,11...,:...,. _ Signature: Name of Owner or Reresentative: _J-oh-n-n... y_h_a-tc-h-er ate: Time:-=1-1 :... Signature: (NFPA Insection and Testing, 6 of 6)

13 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE RGANIZAnON PROPERTY NAME (USER) ATE: TIME: 9: Name: Siemens Building Technologies Name: Kctcs Glasgow, Bldg. "C" (House) Address: 27 Stanley Gault Address: 129 State Street Louisville, Kentucky 423 Glasgow Kentucky Reresentative: --'-'M=arti"""' ""'"n...;...h"""in=kl=e Owner Contact: Johnny Hatcher License No.: _F;...;.A""'"R'-'-lc..;4..c..58.;;... Telehone: (27) Telehone: (52) MONITORING ENrrrv Contact: Siemens Monitoring Telehone: (877) Monitoring Account Ref. No.: --=11=2==3=5..;;.86;;;... TYPE TRANSMISSION McCulloh Multile ~ igital Reverse Priority ORF Shunt Parallel Phone None Other (Secify) APPROVING AGENCY Contact: Telehone: SERVICE Weekly Monthly Quarterly Semiannually It! Annually Other (Secify) Control Unit Manufacturer: Circuit Styles: Number of Circuits: Software Rev.: Edwards aass B 8 Model Number: ESTl-226 -=::;.,;...;;;c..=~ ~ (15t.FI. Hallway) Last ate System Had Any Service Performed:,--.,...~~ Last ate that Any Software or Configuration Was Revised: QUANrrrY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 Style 4 Style 4 Style 4 Ionization etector Manual Pull Station Heat etector uct Photo etector Alarm Verification Feature is isabled Enabled X (NFPA Insection and Testing, 1 of 6)

14 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION CIRCUIT 5Tvt.E..;:6c... Style Y Four Horn/Strobes and Two Strobes Number of alarm notification aliance circuits: _c;;..._ 2 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity O Style(s) SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage -=12= Ams -=2;;... OVercurrent Protection: Tye Breaker Ams -=2;;... Location (of Primary Suly Panel Board): (b) isconnecting Means Location: Secondary (Standby): Storage Battery: Am-Hour Rating _ 7'""'..;;. o calculated Caacity to oerate system, in Hours: , Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell Nickel-Cadmium Ii::! Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article 7. Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

15 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING YES No WHO Oerator All Johnny Hatcher TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators NOTIFICATION APPLIANCES Audible Visual Seakers Voice Clarity INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. FUNCTlONAL FACTORY MEASURE locatjon & 5/N MCETYPE CHECK TEST SETTING SETTING Main Entrv oor Manual Pull Station Rear Eit oor Manual Pull Station Above FACP Ionization etector 2r111.FI. Restroom Heat etector 2r111.Fl. Restroom uct Photo etector 2nc1.Fl. TOE! of Stairs Manual Pull Station Basement Manual Pull Station Basement Mechanical Rm. Heat etector PASS E! E! FAIL (NFPA Insection and Testing, 3 of 6)

16 SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION LOCATION & 5/N EVICE TYPE CHECK TEST FACTORY SETIING MEASURE SEmNG PASS FAIL * = Manually set the 'Pass' state Comments: All initiating devices assed (NFPA Insection and Testing, 4 of 6)

17 SIEMENS BUILING TECHNOLOGIES, INC. FJRE SAFETY IVISION LOCATION &S/N ~ain Entry 1 51.FI. Hall by FACP 2nd.R. Restroom 2.Fl. Hall Basement Basement Restroom AUIO FAILURES EVICE LIST Hom/Strobe Hom/Strobe Strobe Hom/Strobe Hom/Strobe Strebe EVICE TYPE PASS Comments: All Hom/Strobes worked Proerly. (NFPA Insection and Testing, 5 of 6)

18 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) call-in Signal System Performance EVICE INTERFACE EQUIPMENT OPERATION (Secify) (Secify) (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) SIMULATE OPERATION Secial Procedures: Non Comments: None SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMP~ YES No WHO Monitoring Agency I!! Oerator Building Occuants All Building Management Johnny Hatcher Other (Secify) TIME The following did not oerate correctly: System restored to normal oeration: ate: _ TI me: 1: THIS TESfiNG WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector: Martin Hinkle ate: nme: ~1=... :...,... Signature: Name of Owner or Reresentative: _.J""o,..,hnc,,.n,.z.y_,_H.,,.a...,tch...,._er, ate: nme: -= := Signature: (NFPA Insection and Testing, 6 of 6)

19 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM ATE: TIME: 8: am SERVICE RGANIZAnON PROPERTY NAME {USER) Name: -=Si=em=en=s...;;B=u=ild=in_.g._T.;..;ec=hn=o=log=ies=--- Name: Kctcs Glasgow. Bldg. "A" Address: 27 Stanley Gault Address: 129 State Street Louisville, Kentucky 423 Glasgow Kentucky Reresentative:...;..;M=art~i~n~H=in=~=e OWnerContact: _J~o~h~nn~y~H~a~oc~h=e~r License No.: _F A R Telehone: J27) Telehone: (52) MONITORING ENTITY APPROVING AGENCY Contact: Contact: Telehone: Telehone: Monitoring Account Ref. No.: (System Not Monitored) TYPE TRANSMISSION McCulloh Multile igital Reverse Priority RF Shunt Parallel Phone None (System Not Monitored) SERVICE Wee~y Monthly Quarterly Semiannually Annually Other (Secify) Other (Secify) Control Unit Manufacturer: -=S=u=rl=in=g ModelNumber:...;.;; N~/A~ ~ Circuit Styles: Class B Number of Circuits: 4 Software Rev.: Last ate System Had Any Service Performed: ~~-=---= Last ate that Any Software or Configuration Was Revised: QUANTITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 Style 4 Style 4 Ionization etector Manual Pull Station Heat etector Alarm Verification Feature is isabled _ Enabled X (NFPA Insection and Testing, 1 of 6)

20 SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION CIRCUIT STYLE...;:6;_ Style Y Bells Number of alarm notification aliance circuits: -=- 1 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG UNE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity O Style(s) SYSTEM POWER SUPPUES (a) (b) Primary (Main): Nominal Voltage _1==2:..: Ams -'2=-== vercurrent Protection: Tye Breaker Ams -'2=-== Location (of Primary Suly Panel Board): isconnecting Means Location: Secondary (Standby): Storage Battery: Am-Hour Rating _N:..:.1/~A:... _ Calculated Caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Celt Nickel-Cadmium Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article 7. Legally required standby described in NFPA 7, Artide Otional standby system described in NFPA 7, Artide 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

21 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other {Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING Yes No WHO Ii!! Oerator Ii!! All Ii!! Johnny Hatcher TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS Ii!! Ii!! Ii!! Ii!! Ii!! SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators NA NOTIFICATION APPLIANCES Audible Visual Seakers Voice Clarity Ii!! ~ INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. FACTORY MEASURE LOCATlON & 5/N EVICE TYPE CHECK TEST SETTlNG SETTlNG Basement Room 1 Ionization etector Basement Room 1 Manual Pull Station Basement Room 1, Ionization etector Stora Basement Room 11, Heat etector Kitchen Basement Room 12, Heat etector Vendl!J!J Loun9!l Basement Hall by Room Ionization etector 14 Basement Hall by Room Manual Pull Station 14 Mechanical Room 14 Heat etector Mechanical Room 14 Heat etector 2nd.Fl. Hall bt FACP Ionization etector PASS FAIL (NFPA Insection and Testing, 3 of 6)

22 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & S/N 2nd.Fl. Hall by FACP 2nd.Fl. Ooset by FACP 2nd.Fl. Hall by Room 21 2nd.Fl. Hall by Room 27 2nd.Fl. Storage by Room 28 2nd.Fl. Hall by Room 29 2nd.Fl. Hall by Room 23 2nd.Fl. Hall by Room 24 To of Stairs by Room 3 3rd.Fl. Hall by Room 3 3rd.Fl. Hall by Room 31 3rd.Fl. Storage by Room 37 3rd.Fl. Storage by Room 33 3rd.Fl. HaH by Room 34 To of Stairs by Room 34 3rd.Fl. Room 34 EVICE TYPE Manual Pull Station Heat etector Ionization etector Ionization etector Heat etector Ionization etector Heat etector Manual Pull Station Ionization etector Manual Pull Station Ionization etector Heat etector Heat etector Manual Pull Station Ionization etector Ionization etector CHECK TEST FACTORY SETTING MEASURE SETTING PASS FAIL Comments: Alt lnitiatiqg eyicey worked Proedy. * = Manually set the 'Pass' state (NFPA Insection and Testing, 4 of 6)

23 SIEMENS BUILING TECHNOLOGIES, INC. F IRE SAFETY IVISION LOCATION & S/N 3n:1.A. Han Hall 3tt1.FI. Hall by Room Fl. Hall by Room 23 2"'. Fl. Hall by FACP Basemnt Room 1 Basement Hall by Room 14 AUIO FAILURES EVICE LIST EVICE TYPE Bell Bell Ben Bell Bell Bell PASS FAR. Comments: Bell in basement room 1 in the ceiling failed. Wheelock bell. (NFPA Insection and Testing, 5 of 6)

24 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) Call-in Signal System Performance INTERFACE EQUIPMENT (Secify) (Secify) (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) Secial Procedures: N n EVICE OPERATION SIMULATE OPERATION SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring Agency Building Occuants Building Management Other (Secify) YES No TIME O YES No WHO ~ _O~e~ra_t_or ~ All ~ Johnny Hatcher O TIME The following did not oerate correctly: System restored to normal oeration: ate Time: _9:-- THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE Nf PA STANARS, Name of Insector: Martin Hinkle ate: _ Time: _9,<.,:"'",. Signature: Name of Owner or Reresentative: -=J=oh,.,_,n..,_,_n,.._y...,_H=a=tc=h=er,... _ ate: Time: _9=:..,. Signature: (NFPA Insection and Testing, 6 of 6)