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Sprinkler Test 1
Sprinkler Test 1
2.2
I. AUTOMATIC SPRINKLER SYSTEMS
MINISTRY OF INTERIOR
QATAR CIVIL DEFENSE
FIRE PREVENTION DEPARTMENT
Form SS-ITM-M/E-O-01
Remarks
Notes
1. Fill up color shaded cells with “Y”, “N”, or “N/A”.
2. Additional notes can be added at the last page of this guide.
3. Methods / Frequencies WITHOUT COLOR are referred to Manufacturer’s Recommendation / Technical
Specialists.
4. Methods of Inspection, Testing and Maintenance shall be based on NFPA 13, NFPA 25, NFPA 3, NFPA Fire
Protection System – Inspection, Testing and Maintenance Manual and/or Manufacturer’s recommendation.
Frequency (Y, N, N/A)
Code Item
CONTRACTOR
Semi-annually Annually
I.i INSPECTION
XII.m MAINTENANCE
Code Notes / Comments / Resolution: [Key in the code at the beginning of each note (I, II, III, IV, V,
or VI).]
I , hereby declare that the information filled-up on this form is true and correct
and that all system and equipment is operational except as noted in the comments section of this guide.
(Signature above Printed Name) / Date (Signature above Printed Name) / Date
General
Systems Designation: ___________________________________________________________________
Location of Sprinkler Valve: ______________________________________________________________
Type of Sprinkler System Wet Dry Deluge Pre-action
Make and Model of Sprinkler Valve: _______________________________________________________
Is the building fully sprinklers? YES NO
Is the entire sprinkler systems in service? YES NO
Has the sprinkler system been modified since last inspection? YES NO
Valves
How are valves supervised? Sealed Locked Tampered Switch
Are valves identified with signs? YES NO
Pumps
Is fire pump? Diesel Electric Gasoline Others _______
When was the fire pump last inspected? ___________________________________________________
Is the fire pump in good condition? YES NO
Water Supply
When was the last water supply test made? ________________________________________________
Are reservoirs, tanks or pressure tanks in good conditions? YES NO
Wet System
Is system hydraulically calculated? YES NO
Dry System
Remarks: ____________________________________________________________________________
Deluge Systems
Remarks: ____________________________________________________________________________
Pre-action System
Remarks: ____________________________________________________________________________
MINISTRY OF INTERIOR
QATAR CIVIL DEFENSE
FIRE PREVENTION DEPARTMENT
Form SS-ITM-M/E-O-01
SN SIGNIFICANT COMMENTS
APPROVED REJECTED
(Signature above Printed Name) / Date (Signature above Printed Name) / Date