Confidence Test Report Form - Smoke Control System - Seattle Fire Department printable pdf download

This is a Federal Building 

Seattle Fire Department

Confidence Testing Company

Name

Confidence Test Report (use one form per sys.)

Address

206-386-1448 Confidence Testing Officer

Phone

206-615-1068 (fax)

Here

206-233-7219 Red Tag Hotline

SMOKE CONTROL SYSTEM

Status Given



REACCEPTANCE TEST

CONFIDENCE TEST

RED

YELLOW

WHITE

Occupancy Address:

______________________

Occupancy Name:________________________

Responsible Person

First & Last Name:

______________________

Phone Number:

_____________________

Responsible Person

Responsible Party

______________________

_____________________

Address, City, State, Zip:

E–Mail Address

Technician’s Name _______________________

SCP-_______________

SFD Certification No.

(Please Print legibly)

Date of Test:_________________________

Annual

Test Frequency

Mechanical 

System Type:

System Designer:

______________________

Passive 

System Identification No.

________________

System Location:

_____________________

SFD ID No. ________________

(Call 386-1448 for this No.)

? Yes  No 

List items that were not corrected at the time of the confidence test. Use

EFICIENCIES

OUND

the Deficiencies section or attach itemized sheet

REPAIRS: All deficiencies have been corrected 

Corrected By: ___________________________

SFD Certification Number: SCP –____________

The System Status has been changed to White (including the tag on the system) 

This certifies that this fire and life safety system has been properly inspected for functional operation in accordance with the

current Seattle Fire Code (SFC), Administrative Rules, and NFPA Standards adopted by the SFC for this system. The

discrepancies found are noted in the report and have been reported to the building Owner/Manager for corrective action.

Signature of Technician

__________________________ Phone #

______________________

Name of Testing Company __________________________________________________________

Building Representative

(signature) ______________________________Date ______________

Print Name and Title_________________________________ Direct Phone # ________________

Building Rep unavailable  Building Rep declined to sign report 

THIS REPORT WILL BE SENT TO THE SEATTLE FIRE DEPARTMENT BY THE TESTING AGENCY IN ACCORDANCE WITH

ADMINISTRATIVE RULE 9.02.09

ALL DEFICIENCIES RECORDED ON THIS REPORT SHALL BE CORRECTED WITHIN 30 DAYS OF THE TEST DATE

Smoke Control System 9-2012 Ver.1.3

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Confidence Test Report Form - Smoke Control System - Seattle Fire Department

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