Underwriters Laboratories Inc. FIRE ALARM SYSTEM PRE-INSPECTION DATA SHEETS PLEASE RETURN COMPLETED FORMS TO UL PRIOR TO INSPECTION PROTECTED PROPERTY City: State: Zip Code: ALARM SERVICE COMPANY File No.: Service Center No.: City: State: Zip Code: Representative: (Name & Title) Note: Clarify location or area of coverage, as needed. Phone Number: ( ) COMMENTS AND CLARIFICATIONS ALARM SYSTEM DESCRIPTION Page 1
Complete each section that describes the system. SYSTEM TYPE Type of System: (System is installed and maintained in compliance with Standard identified.) (Check one only) Central Station Local Auxiliary Remote Station (Check one only) Proprietary NFPA 71 NFPA 72 NFPA 72A NFPA 72B NFPA 72C NFPA 72D Edition(year) Area Covered/Location: (Building(s), Floor(s), or Area(s)) Authority Having Jurisdiction, ie, Requiring Certification: (Specify Name and Phone Number, if known) Responding Fire Department: System Testing and Maintenance: Date of Periodic Testing and Maintenance Contract: Note: Variations in testing and maintenance procedures from Standard shall be shown in Deviations section. AUTOMATIC FIRE DETECTION AND ALARM SERVICE Coverage: Total Selected Area Partial (Describe Under "System Deviations") Total - Detectors are installed in all areas, rooms, and spaces, as defined in Standard NFPA 72E or NFPA 72 (National Fire Alarm Code) Chapter 5 Selected Area - Same code requirements as total coverage but protection is only provided for a specificly defined area(s) of the protected property. Indicate specific areas protected in Comments section, page 1. Partial - Deviations from Total or Selected Area coverage. Protection provided is less than required by code in some way. Number of devices and their locations shall be specified. Smoke Detectors Ion Photo Duct Detectors Ion Photo Heat Detectors ROR Fixed Temp. Combo Fixed Temp./ROR Other: SPRINKLER SYSTEM WATERFLOW ALARM AND SUPERVISORY SERVICE Page 2
Note: If all sprinkler risers and water shutoff valves are not supervised, show in Deviations Section. Type of System: Wet Pipe Dry Pipe Waterflow Switches (Includes water pressure type) Sprinkler Valve Supervisory Switches Other Supervisory Services: Water Pressure Devices Air Pressure Devices Fire Pump Power Devices Water Temperature Devices Room Temperature Devices Fire Pump Running Devices Water Level Devices Other: MANUAL FIRE ALARM AND GUARD'S TOUR SUPERVISORY SERVICE Note: If proper number of fire alarm boxes required by Standard is not installed, show in Deviations Section. Manual Fire Alarm Boxes Guard Tour Stations Combination Manual Fire Alarm and Guard Tour Stations ALARM NOTIFICATION AND ANNUNCIATION DEVICES Note: If quantity and location of alarm notification devices does not comply with the Standard, show in Deviations Section. Bells Horns Chimes Visual Signals Type: Light Strobe Graphic Audible/Visual Signals Type: Light Strobe Graphic Others: EMERGENCY VOICE ALARM SERVICE Note: If quantify and location of devices does not comply with the National Fire Alarm Code or other NFPA 72-Series Standards, show in Deviations Section. Page 3
Voice/Alarm Channels Speakers Speaker Zones Telephone o r Telephone Jacks Fire Service CONTROL PANEL COMPONENT DESCRIPTION Manufacturers and Model Nos. Indicate model numbers and manufactures of all control units, sub-controls, annunicators, transmission devices and any components used within these units.. Do not include initiating device model numbers. Manufacturer & Model Nos. Description If additional space is needed, please attach a separate sheet REMOTE MONITORING Page 4
Monitoring Location:(Check one only. Choose from None, Fire Department, Proprietary or Central Station) None Fire Department Dispatch Center Proprietary Supervising Station City, State & Zip: Central Station (Information in this dashed box need only be completed if a Central Station does the monitoring) City, State & Zip: File No. Service Center No. Alarm Retransmission to Fire Department: Primary Secondary Code Transmitter Direct Telephone Line Public Telephone Network Private Communication System 911 Emergency Services Alarm Transmission Method ( Co mplete for for all remote monitoring locations except " None"): Multiplex Direct Wire Derived Channel Remote Radio System (Two-Way) Radio Network/Transport System (Two-Way) Transmitter (McCulloh) Private Radio System (One-Way) Radio Network/Transport System (One-Way) Digital Alarm Communicator Cellular Digital Alarm Communicator SYSTEM DEVIATIONS FROM REFERENCED NFPA STANDARDS Note: If service provided (i.e., periodic testing, maintenance, response, or coverage) is not in accordance with NFPA Standard specified, the details must be shown in this section. Page 5