Inspection Report Nursing Home Life Safety Code Section 4 - Annual Fire Alarm Testing and Maintenance. For

Transcription

1 Inspection Report Nursing Home Life Safety Code Section 4 - Annual Fire Alarm Testing and Maintenance For CarDon & Associates Fall Creek Health & Living Prepared by: L.Thompson/T.Roe 7/31/2014 Report Length: 2 Pages

2 System Left In Service? Sheet 2 of West Carmel Drive, Carmel, Indiana KMP Annual Scope (X) REPORT/BILL TO CarDon & Associates BUILDING OR LOC. Fall Creek Health & Living STREET 625 East Water Street INSPECTOR L.Thompson/T.Roe SUITE/UNIT DATE CITY & STATE Pendleton, IN PHONE (317) Testing Method: USAutomatic Fire and Security ALARM & DETECTION EQUIPMENT TEST REPORT ABBREVIATIONS TO USE: MS Manual Pull Station PIV PIV Tamper Switch HD-FT Heat Detector - Fixed Temp TB Trouble Bell S-MS Suppression Manual Station BFV BFV (Internal) Tamper Switch HD-RR Heat Detector - Rate of Rise AB Alarm Bell AS Abort Switch PD Photoelectric Detector UV-IR Ultra Violet Flame Detector HS Horn Strobe LAS Low Air Switch ID Ionization Detector IF-D Infrared Flame Detector H Horn PS Pressure Switch DSD Duct Smoke Detector SS Speaker Strobe WF Waterflow Switch OSY OSY Tamper Switch BSD Beam Smoke Detector SP Speaker RI Remote Indicator Location Zone or Device Manufacturer Model Visual Funct'l Factory Measured Trip Pass Fail Address Type Check Check Setting Setting Time (Sec) 1. RISER ROOM 21 OSY POTTER OSYSU2 X X N/A N/A N/A Pass 2. RISER ROOM 22 OSY POTTER OSYSU2 X X N/A N/A N/A Pass 3. RISER ROOM 25 BFV KENNEDY 823 X X N/A N/A N/A Pass 4. RISER ROOM BFV CENTRAL 48S8 X X N/A N/A N/A Fail 5. RISER ROOM WF POTTER VSR-F X X N/A N/A 47 Pass 6. RISER ROOM WF POTTER PS40-2 X X N/A N/A instant Pass 7. RISER ROOM PS POTTER PS40-2 X X N/A N/A N/A Pass 8. OUTSIDE PIV OSY POTTER PCVS-2 X X N/A N/A N/A Fail Recommendations: 2 device(s) failed testing. See Deficiency and Recommendation reports for details. G:\Inspections\_0_Review Que\[0664Q3_Cardon Fall Creek_ xlsm]ADE1 Version: Last Revised: 08/02/2014

3 Inspection Report Nursing Home Life Safety Code Section 6 - Automatic Sprinkler System Including: Quarterly Inspection & Testing For CarDon & Associates Fall Creek Health & Living Prepared by: L.Thompson/T.Roe 7/31/2014 Report Length: 3 Pages

4 System Left In Service? Sheet 2 of 3 KMP USAutomatic Fire and Security 177 West Carmel Drive, Carmel, Indiana REPORT OF INSPECTION Annual Scope (X) REPORT/BILL TO CarDon & Associates BUILDING OR LOCATION Fall Creek Health & Living STREET 625 East Water Street INSPECTOR L.Thompson/T.Roe SUITE/UNIT DATE CITY & STATE Pendleton, IN PHONE (317) Owner's Section (To be answered by owner or occupant.) A. Explain any occupancy hazard changes since the previous inspection. None B. Describe fire protection modifications since last inspection? None C. Describe any fires since last inspection? None N/A No D. When was the system piping last checked for obstructive materials? N/A E. When was the dry-piping system last checked for proper pitch? N/A F. Are dry valves adequately protected from freezing? G. Have all fire pumps been tested to their full capacity via hose streams within the past 12 months? N/A H. Are gravity, surface or pressure tanks protected from freezing? N/A Inspector's Section (all responses reference current inspection) 1. GENERAL N/A No a. Is the building occupied? b. Are all systems in service? c. Is there a minimum of 18" (457 mm) clearance between the top of the storage and the sprinkler deflector? d. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics and perimeter areas, where accessible? Do all exterior openings appear to be protected against freezing? e. Does the hand hose on the sprinkler system appear to be satisfactory? N/A 2. CONTROL VALVES (See item 14) a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position? b. Are all control valves in the open position and locked, sealed or equipped with a tamper switch? No 3. WATER SUPPLIES (See item 15) a. Was a water flow test made at the sprinkler riser? No 4. TANKS, PUMPS, FIRE DEPARTMENT CONNECTIONS Applicable? a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? N/A b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? C. Are they accessible and visible? 5. WET SYSTEMS a. Are cold weather valves (O.S. & Y.) in the appropriate open or closed position? N/A b. Have antifreeze system solutions been tested? N/A c. Were the antifreeze test results satisfactory? Freezing point: Deg. F N/A 6. DRY SYSTEMS (See items 10-12) Applicable? a. Is dry valve in service? b. Are the air pressure and priming water level in accordance with the manufacturer's instructions? c. Has the operation of the air or nitrogen supply been tested? Is it in service? N/A d. Were low points drained during this inspection? N/A e. Did quick-opening devices operate satisfactorily? N/A f. Did the dry valve trip properly during the trip pressure test? N/A g. Did the heating equipment in the dry-pipe valve room operate at the time of inspection? 7. SPECIAL SYSTEMS (See item 16) Applicable? No a. Did the deluge or pre-action valves operate properly during testing? b. Did the detection devices operate properly during testing? c. Did the supervisory devices operate during test? 8. ALARMS a. Did water motor gong test satisfactorily? N/A b. Did electric alarm test satisfactorily? N/A c. Supervisory alarm service test satisfactorily? 9. SPRINKLERS a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge? b. Are all sprinklers less than 50 years old, thus not requiring sample testing? c. Is stock of spare sprinklers available? d. Does the exterior condition of sprinkler system appear to be satisfactory? e. Temperature. Are sprinklers of proper temperature ratings for their locations? G:\Inspections\_0_Review Que\[0664Q3_Cardon Fall Creek_ xlsm]Spk Version: Last Revised: 08/02/

5 USAutomatic Fire and Security System Left In Service? Sheet 3 of West Carmel Drive, Carmel, Indiana KMP REPORT OF INSPECTION BUILDING OR LOCATION Fall Creek Health & Living DATE Wet Systems Quantity: 1 Make/Model: Wet riser with vane type flow switch Dry Systems Quantity: 1 Make/Model: CSC dry pipe valve Special Systems Quantity: Type: Make and Model? Condition? TRIP TEST TABLE DRY VALVE MAKE MODEL SERIAL NO. Q.O.D. MAKE MODEL DRY PIPE CSC N/A N/A SERIAL NO. N/A OPERATING TIME TO TRIP TIME WATER ALARM TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED CONNECTION* PRESSURE PRESSURE AIR PRESSURE TEST OUTLET* PROPERLY MIN. SEC. PSI PSI PSI MIN. SEC. YES NO W/O Q.O.D N/A N/A YES With Q.O.D. IF NO, EXPLAIN DELUGE & OPERATION PREACTION PIPING SUPERVISED DETECTING MEDIA SUPERVISED VALVES DOES VALVE OPERATE FROM THE MANUAL TRIP AND / OR REMOTE CONTROL STATIONS IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN: FOR TESTING MAKE MODEL SERIAL NO. DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE MINUTES: SECONDS: PneumaticElectric Hydraulic Sealed Locked Supervise Sealed/LockedSealed/Superv Locked/SupervSealed/Locked 14. CONTROL VALVE MAINTENANCE TABLE Open Signs Secured If yes, how? Supervision Operatonal CONTROL VALVES Number Type No No No Sealed/Locked/Supvd? No City Conn. Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves 3 PIV/OSY Supervised System Control Valves 2 BFV No No Other Control Valves 15. WATER FLOW TEST 1/2" 3/4" 1" 1-1/4" 1-1/2" 2" Water Pressure? City PSI Tank PSI Fire Pump PSI Jocky Pump PSI Water flow test? (If none made Why?) Test Pipe Located Size Pressure Flow Pressure Test Pipe Located Size Pressure Flow Pressure Test Pipe Before Pressure After Test Pipe Before Pressure After RISER ROOM 1-1/4" RISER ROOM DRY 2" SPRINKLER HEAD TYPES: 1/2" 3/4" 1" Upright Pendent Hsidewall Vsidewall DryPend DrySidewall Make Model/SIN# Thread Size Temperature Orientation Location or Description Make Model/SIN# Thread Size Temperature Orientation Location or Description CENTRAL 804A 3/4" 165 Upright GLOBE GL5651 1/2" 155 Pendent CEILING AREA CENTRAL BB1 3/4" 200 Upright ATTIC 17. EXPLAIN ANY "NO" ANSWERS AND COMMENTS: See Deficiency and Recommendation Reports DRY VALVE TAMPER IS NOT WIRED TO PANEL TO RECEIVE A TROUBLE IF DEVICE IS CLOSED 18. ADJUSTMENTS OR CORRECTIONS MADE DURING THIS INSPECTION: 19. ALTHOUGH THESE COMMENTS ARE NOT THE RESULT OF AN ENGINEERING REVIEW, THE FOLLOWING DESIRABLE IMPROVEMENTS ARE RECOMMENDED: 20. INSPECTION AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE UNDERSIGNED OWNER OR OWNER'S REPRESENTATIVE. NOTE: ALL SYSTEMS WERE RETURNED TO SERVICE EXCEPT THOSE OUTLINED IN THIS REPORT. Signature of owner or owner's representative: Date: G:\Inspections\_0_Review Que\[0664Q3_Cardon Fall Creek_ xlsm]Spk2 Version: Last Revised: 08/02/2014

6 Inspection Report Nursing Home Life Safety Code Section 12 - Fire Extinguisher Annual Inspection For CarDon & Associates Fall Creek Health & Living Prepared by: L.Thompson/T.Roe 7/31/2014 Report Length: 2 Pages

7 System Left In Service? USAutomatic Fire and Security 177 West Carmel Drive, Carmel, Indiana KMP FIRE EXTINGUISHER INSPECTION REPORT Sheet 2 of Annual Scope (X) REPORT/BILL TO CarDon & Associates BUILDING OR LOCATION Fall Creek Health & Living STREET 625 East Water Street INSPECTOR L.Thompson/T.Roe SUITE/UNIT DATE CITY & STATE Pendleton, IN PHONE (317) Fire Extinguisher Total Quantity: Size Type (ABC, MFG 6 Year 12 Year Serial # Brand Tagged (lbs) Purple K) Date Due Due Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Amerex 10 X ABC Badger 10 X ABC Location Next to Mechanical Kitchen Next to room 205 Next to room 20 Kitchen Next to room 10 Next to mech room Next to sun room Next to room 26 Next to room 406 Next to room 114 Next to room 107 Next to room 303 G:\Inspections\_0_Review Que\[0664Q3_Cardon Fall Creek_ xlsm]Ext1 Version: Last Revised: 08/02/2014

8 System Left In Service? KMP USAutomatic Fire and Security 177 West Carmel Drive, Carmel, Indiana ADDENDUM REPORT: DEFICIENCIES Appendix D Annual Scope (X) REPORT/BILL TO CarDon & Associates BUILDING OR LOCATION Fall Creek Health & Living STREET 625 East Water Street INSPECTOR L.Thompson/T.Roe SUITE/UNIT DATE CITY & STATE Pendleton, IN PHONE (317) Inspections performed in accordance with NFPA 25 are intended to verify proper operation of installed components. Items noted below are deficiencies, that if not corrected, could affect proper operation of your fire protection system and therefore require corrective action in accordance with NFPA Notes/Comments Inspector Note: Take pictures of any deficiency. Initial Date 1. DRY VALVE TAMPER IS NOT WIRED SO IT WILL NOT REPORT TO THE PANEL LT 7/31/ PIV TAMPER DID NOT REPORT TO THE PANEL LT 7/31/2014 G:\Inspections\_0_Review Que\[0664Q3_Cardon Fall Creek_ xlsm]Add D.1 Version: Last Revised: 08/02/2014