WATER BASED FIRE PROTECTION SYSTEM TEST REPORT

**Only this document will be accepted by the Mount Laurel Fire Prevention Division for fire alarm testing purposes
as required by the New Jersey Uniform Fire Safety Code and applicable N.F.P.A. Standards
DATE:
NOTE: ANY deficencies MUST be reported to the Bureau of Fire TIME:
Prevention at 856-234-6053.

SERVICE ORGANIZATION PROPERTY NAME (USER)

Name: Name:
Address: Address:
Representative: Owner Contact:
License #: Telephone:
Telephone:

SERVICE □ Weekly □ Monthly □ Quarterly □ Annually

Wet Sprinkler System Inspection

Y N/A N Y N/A N
Prior inspection reports, logs and test data on site? Modifications to system documented?
Plans of systems on site? Weekly logs of inspections on file?

Sprinkler supply gauge: psi Sprinkler supply gauge with main drain flow ____ psi.
Sprinkler system gauge: psi Sprinkler system gauge with main drain flow ____ psi.

Y N/A N Y N/A N
System in service on inspection Head appears free of paint
Sprinkler control valve locked/tamper open Heads appear free of non approved coverings
Standpipe control valve locked/tamper open Standard head less than 50 year
Backflow valve locked open/tamper Residential head less than 20 year
Anti-freeze system valve locked/tamper open Watt hydrant plainly visible
Tamper switches appear operational Watt hydrant easily accessible
Valve area accessible Watt hydrant identification plate in place
Control valves accessible Hose/hydrant house free of damage
P
Pressure l ti valve
regulating l isi open Hose/hydrant
H /h d t house
h fully
f ll equipped
i d
Pressure regulating valve in good condition Hose/hydrant house is accessible
Pressure regulating valve leak tight Wet pipe areas appear properly heated
Pressure regulating valve maintaining down-
stream pressure per design criteria Hydraulic nameplate attached
Pressure relieve valve in closed position Strainers and filters cleaned
except when operational Exterior alarms properly identified
Pressure relieve false in good condition
Pressure relief valve leak tight Main drain flow test with _____ inch valve
Pressure relieve valve maintaining up-stream full open
pressure per design criteria Water flow alarm devices activated
Main check valve holding pressure Interior building alarms operating
Alarm check valve exterior free of damage Exterior alarms operating
Water flow switch operational Inspectors test flow ______ psi
Trim piping leak tight Time to ring alarm from alarm check valve ____ min ____ sec
Retard chamber leak tight Time to ring alarm from alarm pressure switch __ min ___ sec
Alarm drain drip tight when not operational Gauges appear operating properly
Trim valves in appropriate position Did alarm supervisory company receive signal
Alarm test line valve closed Did alarm panel reset properly
FDC plainly visible
FDC easily accessible Prior to freezing season, owner is resp. for bldg
FDC swivels non-binding rotation to be in secure condition and properly heated
FDC caps/plugs in place Visual: bracing and piping are secure, attached
FDC gaskets/signs in place and in good condition
FDC check valve drip free Piping appears free of leakage
FDC ball drip drain drip free Piping appears free of corrosion
Exterior alarms appear operational Piping appears properly aligned
Interior alarms appear operational Piping appears free of external loads
Extra heads in spare head cabinet Sprinklers appear free of corrosion
Heads appear of proper temperature Sprinklers appear properly positioned
Head wrench for each type of head Sprinklers appear properly spaced
Head in cooler appears free of ice, corrosion Sprinklers free of foreign material
Head appears free of leakage or damage Sprinkler spray patterns appear free of obstructions
Mount Laurel Fire Department Page 1 of 2 Phone: 856-234-6053, FAX: 856-234-3756
Control valve lubricated Y N/A N
Control valve operated to closed position and returned to open position
Backflow assembly control valves lubricated
Backflow assembly valve operated and returned to open position
Post indicator valve operated with number of turns recorded ______
Post indicator valve returned to open position (valves left 1/4 turn from wide open)
Antifreeze solution checked to provide adequate freeze protection (protection temp ______ ◦F)

TEST FREQUENCY ITEMES OF 5 YEARS OR GREATER

Internal inspection last date (5 years) ______ Y N/A N
Alarm check valve
Flow tested pressure regulating control valves***** ***** Provide additional pages if necessary to
Make record the:
Model Volume of flow _______ gpm
Size Supply side pressure ______ psi
Date System side pressure ______psi
Check valve
Strainers Comments:
Filters
Trim orifices
Other
Gauge maintenance: date last tested (5 year) _____
Replaced date
Calibrated date
Sprinkler maintenance test
(5 year)
High temp. date _____
(20 year, then 10 year thereafter)
Fast response date _____
Residential head 20 year
(50 year, then 10 year thereafter)
Standard sprinkler date _____

ALL "NO"
NO ANSWERS TO BE FULLY EXPLAINED

NOTIFICATION THAT TESTING IS COMPLETE Who Time

Building Management □ □
Monitoring Agency □ □
Building Occupants □ □
Other (Specify) □ □

The following did not operate correctly:

System restored to normal operation: Date: Time:

THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS

Name of Inspector: Date: Time:

Signature:

Name of Owner or Representative: Date: Time:

Signature:

Mount Laurel Fire Department Page 2 of 2 Phone: 856-234-6053, FAX: 856-234-3756