Inspection, Testing, And Maintenance Foam-Water Sprinkler Systems - Nfpa 25, Chapter 11 As Amended By Ccr, Title 19 Page 4

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Inspection, Testing, and Maintenance Foam-Water Sprinkler Systems
NFPA 25, Chapter 11 as amended by CCR, Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance: ___________________
System Riser ID: __________
Property Information:
Name:
__________________________________________
Abbreviation Key:
I = Inspection
Address: __________________________________________
T = Test
M = Maintenance
__________________________________________
A-O = After Operation
MI = Per Manufacturer’s Instructions
City:
__________________________________________
NFPA 25
Item
Activity
Frequency
Description
Fail
N/A
Pass
Reference
3.20
M
5-Years
Pressure Vacuum Vents
11.4.8
Annually
5-Years
3.21
M
Deluge Pre-action Valves
11.2.1
A-O
MI
See water storage
3.22
M
Water supply tank(s)
Chapter 9
tank form.
3.23
M
See fire pump form
Fire pump(s)
Chapter 8
3.24
M
Per AHJ and MI
Back flow prevention
12.6.3
Check valve(s) (including detector check
3.25
M
MI
12.4.2.2
valves)
3.26
M
See NFPA 72
Detection system
11.2.2
Deficiencies and Comments:
Item
Deficiencies and Comments Item number must correspond to the item number of the activity listed above:
 See Continuation Page (s) ____ (Indicate the number of continuation pages)
 PASS
 FAIL
______________________________
_________________________
SIGNATURE
DATE
Inspection Document NFPA_Foam-Water Sprinkler Systems.Doc
Revised by Lawhorn & Tam on 1/5/2010

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