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Pre-Engineered Restaurant Fire Suppression Systems Report
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Pre-Engineered Restaurant Fire Suppression Systems Report
Pre-Engineered Restaurant Fire Suppression Systems Report
Name:
*
Address:
City:
State
Zip
Phone:
Store No:
Owner or Manager :
Date of Service
MM slash DD slash YYYY
Time
:
Hours
Minutes
AM
PM
AM/PM
Service Type:
Annual
Semi-Annual
Recharge
Installation
Renovation
Location of System Cylinders:
UL 300
Yes
No
Manufacturer:
Model No:
Wet
Dry
CYLINDER SIZE MASTER
CYLINDER SIZE SLAVE
CYLINDER SIZE SLAVE
Fuse Links 360°
Fuse Links 450°
Fuse Links 500°
Other
Fuel Shut-off:
Electric
Gas
Size:
Serial No:
Last Hydro Test Date:
Last Recharge Date:
Manufacturer’s Manual Reference:
Page No:
Drawing No:
Date:
MM slash DD slash YYYY
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
1. All appliance properly covered w/ correct noz zles
Yes
No
N/A
2. Duct and plenum covered w/ correct nozzles
Yes
No
N/A
3. Check positioning of all nozzles
Yes
No
N/A
4. System installed in accordance w/MFG UL listing
Yes
No
N/A
5. Hood/duct penetrations sealed w/weld or UL device
Yes
No
N/A
6. Check if seals intact, evidence of tampering
Yes
No
N/A
7. If system has been discharged, report same
Yes
No
N/A
8. Pressure gauge in proper range (if gauged)
Yes
No
N/A
9. Check cartridge weight (if applicable)
Yes
No
N/A
10. Hydrostatic test date
Yes
No
N/A
11. 6 year maintenace date
Yes
No
N/A
12. Inspect cylinder and mount
Yes
No
N/A
13. Operate system from terminal link
Yes
No
N/A
14. Test for proper operation from remote
Yes
No
N/A
15. Check operation of micro switch
Yes
No
N/A
16. Check operation of gas valve
Yes
No
N/A
17. Clean nozzles
Yes
No
N/A
18. Proper nozzle covers in place
Yes
No
N/A
19. Check fuse links and clean
Yes
No
N/A
20. Replaced fuse links
Yes
No
N/A
21. Check travel of cable nuts/S-hooks
Yes
No
N/A
22. Piping & conduit securely bracketed
Yes
No
N/A
23. Proper separation between fryers and flame
Yes
No
N/A
24. Proper clearance-flame to filters
Yes
No
N/A
25. Exhaust fan in operating order
Yes
No
N/A
26. All filters replaced
Yes
No
N/A
27. Fuel shut-off in on position
Yes
No
N/A
28. Manual & remote set/seals in place
Yes
No
N/A
29. Replace system covers
Yes
No
N/A
30. System operational & seals in place
Yes
No
N/A
31. Slave system operational
Yes
No
N/A
32. Clean cylinder & mount
Yes
No
N/A
33. Fan warning sign on hood
Yes
No
N/A
34. Personnel instructed in manual operation of system
Yes
No
N/A
35. Proper hand portable extinguishers
Yes
No
N/A
36. Portable extinguishers properly serviced
Yes
No
N/A
37. Service & Certification tag on system
Yes
No
N/A
COMMENTS: Note discrepancies or deficiencies below.
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17A, 96 and the manufacturer’s manual and was operated according to these procedures with results indicated above.
Service Technician
Permit No.
Date/Time
Customer’s Authorized Agent
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report
