FIRE ALARM INSPECTION AND CERTIFICATION REPORT BUILDING NAME : — a et ae SITE ADDRESS : = = — DATE TESTED : Mf # of zones Trouble e saa a) Remote Annuciator _ Manual Pull Stations | Audible / Visual Devices ‘Heat Detectors ‘Smoke Detectors | Smoke Alarms | “Door Holders | Flow / Aiarm Switches — Tamper Switches _ = wind = Low Air Switch = Aare there any alarm or Trouble conditions (Audible or Visual) on panel before commencing service? Yes _| No | “i If yes please explain. in — Battery size / type description 12“ =" Tested with AC power turned OFF? ‘Yes (No Batt volt under toad i a Sane ———— —____—. vring Does batteries have adequate capacity? Yes [| N Connected to charger? Yes| | Nol | Is the main power turned back on? Yes If no please explain __ Is the fire pane! clear an back on line? Yes(= | No | If no please explain a System Monitored: No [| Yes [| Monitoring Company Name and # a eee Received Alarm and/or Tiouble signal? Yes [_] Nol COMMENTS AND/ OR REPAIR INFO _— * Te Technician’s Signature Customer's Signature Failure to correct vital fire safety equipment could result in the client being liable in an emergency situation.