Confidence Test Report Form - Foam System - Seattle Fire Department Page 3
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4This is a Federal Building
19. The dry type sprinkler heads are less than 10 years old.
If “No” have the heads sample tested or replaced per 2008 NFPA 25
N/A
Yes
No
and at the prescribed intervals thereafter.
Due date for sample testing: ___________
20. The proper number of spare sprinkler heads is available, with the proper wrenches
Yes
No
for each, at the riser or another designated location.
21. The flow from the foam generating device produces the amount of foam
required by the design, at the minimum pressure, from the water supply. (5-year
Yes
No
test only – full dump is not required) (Destructive testing is not required)
22. The Main Drain flow test did not reveal problems that require further investigation.
Yes
No
Static pressure ____ psi
Flow pressure ____ psi
Return to static pressure ____min/sec
23. Flow from the inspector’s test valve activates the system alarms.
Yes
No
24. The 5-year Obstruction Examination of the sprinkler piping is up-to-date in
accordance with 2008 NFPA 25 Chap. 14. (eff. 10/21/2012)
Yes
No
Date for next Piping Obstruction Examination__________________
F
D
C
(FDC)
IRE
EPARTMENT
ONNECTIONS
25. The FDCs are visible from the street, and are unobstructed by bushes, walls,
Yes
No
barriers, etc.
26. All caps and plugs on the FDC are in place.
Yes
No
27. If a plug or cover was missing from a FDC the piping was inspected for debris in
Yes
No
accordance with 2011 NFPA 25 Sec. 13.7.2, 13.7.4, and Table 13.8.1
28. All caps and plugs have at least 12” clearance for operating wrenches.
Yes
No
29. All swivels turn freely.
Yes
No
30. The 5-year obstruction investigation of Fire Department Connection (FDC) piping is
up-to-date in accordance with 2008 NFPA 25 Chap. 14. (eff. 10/21/2012)
Yes
No
Date for next FDC obstruction investigation _____________
31. The 5-year obstruction investigation of the FDC piping included testing and
operation of the check valve.
R
ECALLS
32. The inspector did not find recalled devices during the visual
inspection.
Unk
Yes
No
Note: the inspector’s inspection is a visual cursory inspection
from the floor level in accessible areas
F
A
M
IRE
LARM
ONITORING
33. A signal was received at the Central Station monitoring company?
N/A
Yes
No
34. The foam activation detection system worked properly
N/A
Yes
No
(Include report of alarm system if applicable.)
F
C
INAL
HECKS
35. The Fire Alarm was removed from test mode and/or other
precautionary measures were removed to restore fire alarm
N/A
Yes
No
system to normal operation (includes removal of protective
coverings).
36. The system was left in service.
Yes
No
If “No”, why? ____________________________________________
37. The confidence test report was given to the owner and a current status tag was
Yes
No
posted.
Foam 9-2012 Ver.1.3System
Page 3 of 4
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