5 Year Fire Sprinkler Inspection Form PDF Details

The 5 year fire sprinkler inspection form is a document that must be filled out by the fire department and submitted to the property owner. The purpose of this inspection is two-fold: it ensures that your system is in working order, and it helps you remember when your next inspection will take place. It's important for both safety and legal reasons that you complete this form before submitting it back to the fire department. The 5 Year Fire Sprinkler Inspection Form serves many purposes, one of which being ensuring that your system is in working order.

Here is the details in regards to the file you were looking for to fill out. It will tell you how long it will require to complete 5 year fire sprinkler inspection form, what fields you will have to fill in, and so forth.

QuestionAnswer
Form Name5 Year Fire Sprinkler Inspection Form
Form Length3 pages
Fillable?Yes
Fillable fields221
Avg. time to fill out22 min 30 sec
Other names5 year internal sprinkler inspection report, annual fire sprinkler inspection form, 5 year internal inspection report, nfpa 5 year sprinkler inspection form

Form Preview Example

Wet Pipe

California Code of Regulations - Title 19

5-Year

1 of 3

Fire Sprinkler System

Inspection, Testing, and Maintenance

Report

 

Property Information

 

 

Contractor or Licensed Owner Information

 

 

 

 

 

 

Building Name

 

 

Name

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

Address

 

 

City

St.

Zip

 

 

 

 

 

 

 

 

License #

Phone

 

 

City

 

SFM

Job #

 

 

 

 

 

 

 

 

Contact Person

 

CSLB

Misc.

 

 

 

 

 

 

 

 

 

 

 

Riser Information

 

 

 

 

 

Main Drain Test (ANNUAL)

 

Riser

 

Location

Riser

 

Main Drain

Initial Static

 

Residual

 

Final Static

P, F, N/A

No.

 

Diameter

 

Diameter

Pressure

 

Pressure

 

Pressure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This building has more than 5 risers. See additional AES 2.9 form attached

Number of AES 2.9 forms attached:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5-Year INSPECTION, TESTING AND MAINTENANCE

 

 

 

 

 

 

 

Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance items

 

 

 

 

 

I = Inspection T = Test

M = Maintenance

 

 

 

 

 

P = Pass

F = Fail

N/A = Not Applicable

 

Item

 

 

 

Description

 

 

NFPA 25 CA

 

Date

 

 

Comments Only

P, F, N/A

 

 

 

 

 

 

ed.

 

 

 

 

 

 

 

 

 

Reference

 

 

 

 

 

 

 

 

1.1

 

I

Control Valves – Identification Sign

 

 

13.3.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2

 

I

Control Valves – Inspection

 

 

13.3.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.3

 

I

Waterflow Alarm Devices

 

 

5.2.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.4

 

I

Supervisory Devices

 

 

 

5.2.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.5

 

I

Gauges (Wet Pipe Systems)

 

 

5.2.4.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.6

 

I

Hydraulic Design Information Sign

 

 

5.2.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(For hydraulically designed systems)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.7

 

I

Enter Water Supply Pressure Below Riser Check

 

5.2.4.1

 

 

 

 

 

 

psi

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.8

 

I

Enter Water Supply Pressure Above Riser Check

 

5.2.4.1

 

 

 

 

 

 

psi

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.9

 

I

Pressure Readings Acceptable

 

 

5.2.4.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.10

 

I

General Information Sign

 

 

5.2.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(not required for system prior to 2007 Edition NFPA 13)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.11

 

I

Heat Tape

 

 

 

5.2.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.12

 

I

Spare Sprinklers

 

 

 

5.2.1.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.13

 

I

Fire Department Connections

 

 

13.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.14

 

I

Alarm Valves – Exterior Inspection

 

 

13.4.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.15

 

I

Pressure Reducing Valves

 

 

13.5.1.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.16

 

I

Backflow Preventers

 

 

 

13.6.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form AES 2.2

Sept. 3, 2013

 

 

 

Wet Pipe

 

California Code of Regulations - Title 19

 

5 Year

2 of 3

 

Fire Sprinkler System

Inspection, Testing, and Maintenance

 

Report

 

 

 

 

 

 

 

Property Information

 

 

 

 

Contractor or Licensed Owner Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Building Name

 

 

 

 

Name

 

 

 

 

 

Address

 

 

 

 

 

Job #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

 

 

 

 

 

 

 

Include ALL Quarterly Inspections (See AES 2.1)

 

 

I

 

= Inspection

T = Test

M = Maintenance

 

 

 

 

P = Pass F = Fail N/A = Not Applicable

 

 

Item

 

 

 

Description

NFPA 25 CA ed.

 

Date

 

Comments Only

P,F,N/A

 

 

 

Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.17

 

I

Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

 

 

 

 

 

 

 

 

13.5.5.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.18

 

I

PRV – Fire Sprinkler Systems

13.5.1.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.19

 

I

Buildings (Freeze Protection)

4.1.1.1

 

 

 

 

Owner’s Responsibility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.20

 

I

Sprinklers

 

 

 

5.2.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.21

 

I

Sprinklers - Accessible Concealed Space

5.2.1.1.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.22

 

I

Pipe and Fittings

 

 

5.2.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.23

 

I

Pipe and Fittings - Accessible Concealed Space

5.2.2.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.24

 

I

Hangers

 

 

 

5.2.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.25

 

I

Hangers - Accessible Concealed Space

5.2.3.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.26

 

I

Seismic Braces

 

 

5.2.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.27

 

I

Seismic Braces - Accessible Concealed Space

5.2.3.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.28

 

I

Unsprinklered Areas

 

 

CFC 901.4

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

2.1

 

T

Field Service Test Required

5.3.1

 

 

 

 

If REQUIRED, Enter 'F' until

 

 

 

Send Report to Fire Code Official

 

 

 

 

results are returned from Lab

 

 

 

 

 

 

 

 

 

 

 

 

2.2

 

T

Recalled Sprinklers

 

 

Title 19

 

 

 

 

 

 

 

 

If not present = Pass;

If present = Fail

904.1(c)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.3

 

T

Water Flow Alarm Devices

5.3.3

 

 

 

 

sec.

 

 

 

90 secs max. Enter time

13.2.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.4

 

T

Main Drain Test

 

 

13.2.5

 

 

 

 

 

 

 

 

(Enter data on Page 1 of this form)

13.3.3.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.5

 

T

Control Valve - Position

 

 

13.3.3.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.6

 

T

Control Valve – Operation

 

 

13.3.3.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.7

 

T

Supervisory Devices

 

 

13.3.3.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.8

 

T

Backflow Preventer Assemblies

13.6.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.9

 

T

Small Hose Connections*

 

 

13.5.2.3

 

 

 

 

 

 

 

 

w/PRV Hose Valves – Partial Flow Test

13.5.3.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.10

 

T

PRV – Fire Sprinkler Systems

13.5.1.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.11

 

T

Pressure Gauges - Calibration

5.3.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.12

 

T

Small Hose Connections*

 

 

13.5.6.2.2

 

 

 

 

 

 

 

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems.

Form AES 2.2

Sept. 3, 2013

Wet Pipe

California Code of Regulations - Title 19

5 Year

3 of 3

Fire Sprinkler System

Inspection, Testing, and Maintenance

Report

Property Information

Building Name

Address

City

Contractor or Licensed Owner Information

Name

Job #

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

include ALL Quarterly Inspections (See AES 2.1)

I

= Inspection

T = Test

M = Maintenance

 

P = Pass

F = Fail N/A = Not Applicable

 

Item

 

 

 

Description

NFPA 25 CA ed.

Date

 

Comments Only

P,F,N/A

 

 

 

Reference

 

 

 

 

 

 

 

 

 

 

 

 

3.1

M

Check Valves - Internal inspection

13.4.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.2

M

Control Valves

 

13.3.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.3

M

FDC - Backflush

 

14.3.2.3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.3.2.4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.4

M

Internal Pipe Inspection - See Deficiencies and

14.2

 

 

 

 

Yes

 

 

 

 

 

 

Comments Section for Results.

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

3.5

M

Obstruction Investigation Required. If "Yes", see

14.3

 

 

 

 

 

 

 

 

 

 

 

 

Deficiencies and Comments Section for Results

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.6

M

System Returned to Service

4.5.3

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Deficiency C = Comment (Indicate type )

 

 

 

 

 

 

 

Item

Date

Riser

D C

Deficiencies and Comments

Indicate all equipment, devices and parts that were repaired or replaced

Check here if additional Deficiencies and Comments are listed on Form AES 9

Number attached:

See Correction Form AES 10 for corrected deficiencies.

Number attached:

 

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Print Name

Signature

Date

Form AES 2.2

Sept. 3, 2013

How to Edit 5 Year Fire Sprinkler Inspection Form Online for Free

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Step 2: Now you are allowed to alter nfpa 25 chapter 6. You have a lot of options thanks to our multifunctional toolbar - you can add, delete, or alter the information, highlight the specified areas, as well as undertake other commands.

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portion of spaces in sprinkler testing form

In the Item, Description, I Control Valves – Identification, I Control Valves – Inspection, I Water, flow Alarm Devices, Supervisory Devices, I Gauges (Wet Pipe Systems) I, (For hydraulically designed, Enter Water Supply Pressure Below, (not required for system prior to, I I General Information Sign, I Heat Tape, Spare Sprinklers, Date, and Comments Only box, note down the information you have.

part 2 to finishing sprinkler testing form

Point out the main details of the Fire Department Connections, Alarm Valves – Exterior Inspection, Pressure Reducing Valves, Back, flow Prevent, ers Form AES 2, and Sept part.

Completing sprinkler testing form stage 3

Describe the rights and responsibilities of the sides within the space Name Job #, ANNUAL INSPECTION, Include ALL Quarterly Inspections, M = Maintenance, Building Name Address City, I = Inspection, T = Test, Item, Description, Small Hose Connections - Hose, PR, V – Fire Sprinkler Systems, I Buildings (Freeze Protection) I, I Sprinklers - Accessible, I Pipe and Fittings, and I Pipe and Fittings - Accessible.

sprinkler testing form Name Job #, ANNUAL INSPECTION, Include ALL Quarterly Inspections, M = Maintenance, Building Name Address City, I = Inspection, T = Test, Item, Description, Small Hose Connections - Hose, PRV – Fire Sprinkler Systems, I Buildings (Freeze Protection) I, I Sprinklers - Accessible, I Pipe and Fittings, and I Pipe and Fittings - Accessible blanks to fill out

End up by looking at all these sections and preparing them correspondingly: I Pipe and Fittings - Accessible, I Hangers, I Hangers - Accessible Concealed, I Seismic Braces, I Seismic Braces - Accessible, If not present = Pass; If present, Send Report to Fire Code Official, I Un, sprinkle, red Areas T Field, (Enter data on Page 1 of this form), T Control Valve – Operation, T Supervisory Devices, T Back, flow Prevent, er Assemblies T, w, PR, V Hose Valves – Partial Flow, T Pressure Gauges - Calibration, and Yes If REQUIRED.

stage 5 to filling out sprinkler testing form

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