System Record of Inspection and Testing

This form is to be completed by the system inspection and testing contractor at the time of a system test. It shall be permitted to midify 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.

Inspection/Test Start Date/Time: Inspection/Test Completion Date/Time: Supplemental Form(s) Attached: (yes/no)

Property Information

Name of property:

Address:

Description of property:

Name of property representative:

Address:

Phone: Fax: E-mail:
Testing and Monitoring Information

Testing organization:

Address:

Phone: Fax: E-mail:

Monitoring organization:

Address:

Phone: Fax: E-mail:

Account number: Phone line 1: Phone line 2:

Means of transmission:

Entity to which alarms are retransmitted: Phone:
Documentation

Onsite location of the required record documents and site-specific software:
Description of System or Service
1. Control Unit
  
  Manufacturer: Model number:
2. Software Firmware
  
  Firmware revision number:
3. System Power
  1. Primary (Main) Power
    
    Nominal voltage: Amps: Location:
    
    Overcurrent protection type: Amps: Disconnecting means location:
  2. Secondary Power
    
    Type: Location:
    
    Battery type (if applicable):
    
    Calculated capacity of batteries to drive the system:
    
    In standby mode (hours): In alarm mode (minutes):
Notifications Made Prior to Testing

Monitoring organization Contact: Time:

Building management Contact: Time:

Building occupants Contact: Time:

Authority having juristiction Contact: Time:

Other, if required Contact: Time:

Alarm and Supervisory Alarm Initiating Device

Attach supplementary device test sheets for all initiating devices.
Notification Applicances

Attach supplementary appliance test sheets for all notification appliances.
Interface Equipment

Attach supplementary interface component test sheets for all interface components.

Circuit Interface / Signaling Line Circuit Interface / Fire Alarm Control Interface