Confidence Testing Company
Name:
PIERCE COUNTY FIRE PREVENTION BUREAU
Address:
2401 SOUTH 35TH STREET
TACOMA WA 98409
253-798-7179 OFFICE
253-798-2731 FAX
Phone:
FOR UNICORPORTATED PIERCE CTY BUSINESSES ONLY NOT IN CITY LIMITS
Fire Alarm System
(One System per Report)
Red
Occupancy Address:
Building Owner:
Responsible Person:
Building Owner Address:
Certification Given
Yellow
Occupancy Name:
Phone Number:
Phone Number:
Date of Inspection:
Inspection
Annual
Frequency/Type: Quarterly
Tester’s Name (please print) & Phone Number
Central Station Monitoring Yes
No
System Manufacturer:
Location of System:
Monitoring Company Name:
System Model Number:
System ID Number:
Problems Found:
White
(High Rise Only)
(If additional room is needed, please add a separate sheet)
Corrections Made: (If additional room is needed, please add a separate sheet)
Date Corrected:
Corrected By:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the items listed
in the report and is consistent with the International Fire Code standards, and that discrepancies are noted and
have been reported to the building Owner/Manager for corrective action.
Signature of Tester:
Testing Agency:
Mailing Address:
Phone #:
Building Representative (signature):
K:Forms/Fire Systems/Fire Alarm System Confidence Test
1
The items on the checklist below shall be inspected and tested. This list does not constitute all of the required inspecting
and testing of the fire and life safety system. Refer to the International Fire Code for inspecting and testing requirements.
Alarm System Functionality
Trouble signal with AC power off?
System operates properly on battery backup?
Battery voltage (no load)
volts
Battery voltage (full load)
volts (signals operating)
Charge circuit voltage
volts
System operates properly on standby power?
All signals operate on AC power?
Number of initiating circuits
Number of signal circuits
Does alarm system meet audibility standards?
All circuits checked for electrical supervision?
All auxiliary equipment operates (Elevators, fans, dampers)?
Ventilation controls operate?
Key to panel available?
Operating instructions at panel?
Trouble indicators function properly?
Remote Annunciator Panels function properly?
Elevator Call Down functions properly?
Test record posted at panel?
General alarm automatic time delay
minutes
Was a signal received at the Central Station monitoring company?
Other Devices (specify)
Is there a minimum supply of spare sprinkler heads?
System Devices
Total Number of
Units in Building
Total Number
Units Tested
1. Bells, Horns, Chimes
2. Voice Speakers (Voice Clarity)
3. Smoke Detectors
4. Heat Detectors
5. Duct Detectors
6. Sprinkler Flow Switches
7. Sprinkler Supervisory Switches
8. Visual Alarm Devices
9. Manual Pull Stations
10. Annunciators
11. Beam Detectors
12. Automatic Door Unlocks
13. Automatic Door Release
Communication Equipment
N/A
N/A
N/A
N/A
N/A
N/A
Total Number
Units Tested
14. Phone Sets
15. Phone Jacks
16. Call-In Signal
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Yes
No
N/A
Test Results Acceptable
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Total Number of
Units in Building
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
Test Results Acceptable
N/A
N/A
N/A
Yes
Yes
Yes
No
No
No
SUBMIT
K:Forms/Fire Systems/Fire Alarm System Confidence Test
N:\FPB\FORMS\CONFIDENCE TESTS\FPB Fire Alarm Confidence Testing
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