Confidence Test Report Form - Foam System - Seattle Fire Department Page 2
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1
2
3
4This is a Federal Building
The items on the checklists below shall be inspected and tested. This list may not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code and
adopted NFPA standards for inspecting and testing requirements.
G
ENERAL
1. The Fire Alarm was put into test mode and/or other precautions
N/A
Yes
No
were taken to avoid preventable alarms.
2. This is the only Foam System at this address.
Yes
No
If “No” What is the unique ID number? (See SFC Ad Rule 9.02.09)_________
3. All signs, placards, and labels are provided on doors and system controls as
Yes
No
required by NFPA 16.
R
ECALLS
4. Any recalled parts that have been identified during inspection
No
Yes
No
including heads, valves, switches, etc, have been replaced.
Recalls
F
G
E
OAM
ENERATING
QUIPMENT
5. Control valves, including all automatic and manual actuating devices operate
Yes
No
properly.
6. All control valves are secured or supervised.
Yes
No
7. Supervisory switches operate properly.
N/A
Yes
No
8. The alarm indication device operates properly.
N/A
Yes
No
9. Alarm bells operate properly.
N/A
Yes
No
10. All of the proportioning devices, their accessory equipment, and foam makers
Yes
No
have been inspected, tested, and are functioning properly.
11. A sample of the foam concentrate was sent to a testing laboratory.
Yes
No
(Send test results to FMO
12. The above-ground piping is in good condition and drains properly.
Yes
No
13.
The Underground piping has been spot-checked for deterioration within the last 5
N/A
Yes
No
years as required by 2005 NFPA 11 Sec.11.3.3 Next test Due Date: ___________
14. All the strainers have been inspected and cleaned quarterly (by maintenance)
Yes
No
and as necessary during confidence testing.
15. Maintenance on the system gauges is up-to-date.
Due date for the next comparison test: ____________
Note: The system gauges are to be compared with a calibrated gauge every
five (5) years. If a gauge is not within +/- 3% of the calibrated gauge it must be
replaced or recalibrated. This check should be done for multiple floors at
Yes
No
static pressure using one calibrated gauge and hydraulic calculations.
S
H
P
PRINKLER
EADS AND
IPING
16. Number of Sprinkler Heads: <20
>20
<100
17. All accessible sprinkler heads are free of corrosion, paint, obstructions and/or
Yes
No
physical damage.
(List the location of defective heads in “Problems Found” section.)
18. The standard sprinkler heads are less than 50 years old.
If “No” have the heads sample tested or replaced per 2008 NFPA 25
and at the prescribed intervals thereafter. (not required for deluge
N/A
Yes
No
heads)
Due date for sample testing: ___________
Foam 9-2012 Ver.1.3System
Page 2 of 4
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