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?No
Fillable fields0
Avg. time to fill out45 sec
Other namesfire sprinkler inspection report template, nfpa 25 5 year internal inspection, 5 year internal inspection report, nfpa 25 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

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portion of spaces in 5 year internal sprinkler inspection form

In the Item, Description, NFPA CA ed Reference, Date, Comments Only, P F NA, I Control Valves Identification, I Control Valves Inspection, I Waterflow Alarm Devices, Supervisory Devices, I Gauges Wet Pipe Systems, Hydraulic Design Information Sign, For hydraulically designed systems, Enter Water Supply Pressure Below, and Enter Water Supply Pressure Above box, note down the information you have.

part 2 to finishing 5 year internal sprinkler inspection form

Point out the main details of the Backflow Preventers, Form AES, and Sept part.

Completing 5 year internal sprinkler inspection form stage 3

Describe the rights and responsibilities of the sides within the space Building Name, Address, City, Name, Job, I Inspection, T Test, M Maintenance, P Pass F Fail NA Not Applicable, ANNUAL INSPECTION TESTING AND, Item, Description, Small Hose Connections Hose Valve, PRV Fire Sprinkler Systems, and I Buildings Freeze Protection.

5 year internal sprinkler inspection form Building Name, Address, City, Name, Job, I  Inspection, T  Test, M  Maintenance, P  Pass F  Fail NA  Not Applicable, ANNUAL INSPECTION TESTING AND, Item, Description, Small Hose Connections  Hose Valve, PRV  Fire Sprinkler Systems, and I Buildings Freeze Protection blanks to fill out

End up by looking at all these sections and preparing them correspondingly: I Hangers, I Hangers Accessible Concealed, I Seismic Braces, I Seismic Braces Accessible, I Unsprinklered Areas, CFC, Yes, If REQUIRED Enter F until results, sec, Field Service Test Required Send, If not present Pass If present, Water Flow Alarm Devices secs max, Main Drain Test, Enter data on Page of this form, and T Control Valve Position.

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