SPRINKLER SYSTEM - GENERAL INFORMATION

for Alarm Valve No: Zone No: Total branches: Type of sprinkler:

High-piled storage: Rack storage: Commodity class: Max.storage ht Aisle wdth (min.) Encapsulation Solid shelving: Flammable/

Yes Yes Yes ft ft Yes Yes

NoNo No

N/A N/A

No No

N/A N/A

Date: Flow test data: Static: Resid: Flow: Pitot: Date: Location:

psi psi gpm psi

combustible liquids: Other storage:

Yes Yes

No No

N/A N/A Location of aux/low point drains:

Hazardous materials: Idle Pallets: Antifreeze systems: Location: Dry or aux systems Location:

Yes Yes Yes

No No No

N/A N/A N/A Original main drain test r esults: Static: psi Residual: psi

Yes

No

Name of contractor or designer

address: Phone:

Centrifugal Fire Pump accceptance Test Report

Information on this form covers the minimum requirements of NFPA 20-2007 fo rperforming acceptance tests on pumps with electric motorsor diesel engine drivers.Other forms are available for periodic inspection, testing and maintenance

Owner: Owner Address: Property on which pump is installed: Property Address: Date of Test: Demand(s) of Fire Protection System Supplied By Pumps: Pump: Horizontal Vertical Manufacturer: Shop Serial Number: Model or Type: Rated GPM Rated Pressure: Rated RPM: Suction From If Tank,Size and Height Driver: Electric Motor Diesel Engine Steam Turbine Manufacturer: Shop Serial Number: Shop Serial Number: Modelor Type: Rated Horse Power: Rated Speed: If Electric Motor, Rated Voltage Operating Speed: Rated Amps Phase cycle Service Factor Controller Manufacturer: Shop Serial Number: Modelor Type: Jockey Pump on system? Yes No settings: On Off

E. for the each test, record following for each load condition: Disch Noz Pit Driver Suction Test arge zle ot Speed Pressure Press Size Re rpm psi psi inch 1 2 3 0% 100% 150%

F. For electric motor driven pumps also record: Test 0% 100% 150% Voltage Amperes

G. for the each test, record following for each load condition: Pnet= Pdischarge-Psuction Q=29.83 cd p

Test
Note: All questions are to be answered Yes, No or Not Applicable. All "No" answers are to be explained in the comments portion of this form.

Net Pressure

1 0

2 0

Flow 3 4 0 0

Total Flow

0% 100% Yes Yes No No N/A N/A 150%

I. Flush Test (Conduct before Hydrostatic Test)

Suction piping was flushed at gpm? (See Table 14.1.1.1(a) of NFPA 20.) Cerificate presented showing flush test?

II. Hydrostatic Test

Piping tested at psi for 2 hours? Yes No Note: NFPA 20 requires 200 psi or 50 psi above maximum system Pressure whichever is greater.) N/A

H. For electric motors operating at rated voltage and frequency, is the ampere demamd less than or equal to the product of the full load ampere rating times the allowable service factor

Piping Passed test? Certificate prestented showing test?

Yes Yes

No No

N/A N/A

as stamped on the motor nameplate?

Yes

No

N/A

III. People Present

were the following present to witness the test: A. Pump manufacturer/representative B. Engine Manufacturer/representative C. Controller Switch Manufacturer/representative D. Transfer Switch Manufacturer/representative E. Authority having jurisdiction/representative Yes Yes Yes Yes Yes No No No No No N/A N/A N/A N/A N/A

I. For electric motors operating under varying voltage: 1. Was the product of the actual voltage and current demand less than or equal to the product of the rated full load current times the rated voltage times the allowable service factor? Yes 2. Was the voltage always less than the 5% below the rated voltage during the test? Yes 3. Was the voltage always less than the 5% above the rated voltage during the test? Yes J. Did the engine-driven units show no signs of overload or stress?

No No No

N/A N/A N/A

IV. Electric Wiring

Was all electric wiring including control interwiring for multiple pumps, emergency power supply, and the jockey pump completed and checked by the electric contractor prior to the initial start-up and acceptance test? Yes No Yes No N/A

N/A

K. Was the governor set to properly regulate the engine speed at the rated pump speed?

Yes

No

N/A

V. Flow Test
Run the pump at no-load, rated load and peak load (usaully 150% of rated load) conditions. For variable speed drivers, run the test with the pressure limited control "on" and then again at the rated speed with the pump isolated from the fire protection system and the relief valve closed. A. Was a copy of the manufacturer's ceritified pump test characteristic curve avilable for comparision to the result of the acceptance test? Yes B. Equipment and gages calibrated? Yes C. No vibrations that could potentially damage any fire pump components? Yes D. The fire pump performed at all conditions without objectionable overheating of any components? Yes l. Did the geardrive assembly operative without excessive objectionable noise, vibration or heating? Yes M. Was the fire pump unit started and brought up to rated speed without interruption under the conditions of a discharge equal to peak load? Yes N. Did the fire pump perform equal to the manufacturer's characteristic curve within the accuaracy limits of the test equipment? O. Electric motor pumps passed phase reversal test on normal and alternate (if provided) power? No N/A

No

N/A

No No No No

N/A N/A N/A N/A

Yes

No

N/A

Yes

No

N/A

A B

VI. Controller Test Did the pump start at least 6 times from automatic sources? Was each automatic starting feature teasted at least once?

Yes Yes

No No

C D

Did the pump start at least 6 times manually? Was the pump run for atleast 5 minutes during each of the operation in Parts A,B and C above? (Note: An engine driver is not required to run for 5 minutes at Full speed between successive starts until the cumulative cranking time of successive starts reaches 45 seconds.)

Yes Yes

No No

VIII. Tester information NA Tester: Company: NA Company Address: I state that the information on this form is correct at the time and plof my test, and that all equipment tested was left in operational NA condition upon completion of this test except as noted in the NA comments section below.

Signature of tester: License or Certification Number if applicable: E Were the starting operations divided between both sets of batteries for engine-driven controllers? Yes No NA IX. Comments

Date:

(Any "No" answers, test failures, or other problem must be explained) F 1 2 Electric Driven Pumps Controllers Were all overcurent protective devices (inculding the controller circuitbreaker) selected,sized and set in accordance with NFPA 20? Yes No No NA NA

Was the fire pump started at least once from each power service and run Yes for atleast 5 minutes? Upon simulation of a power failure, while the pump is operating at peak load, did the transfer switch transfer from the normal to the emergency Yes source without opening overcurrent protection devices on either line? When the normal power was restored, did retransfer from emergency to normal power occur without overcurrent protection device opening on Yes either line? Were at least half of the automatic and manual starts required by Parts Yes A and C performed with the pump connected to the alternate sources? Were all signal conditions simulated demonstrating satisfactory operation? H. Was the pump run for at least 1 hours total during all of the above tests? For engines with ECM fuel management Yes Yes

No

NA

No

NA

5 G H I

No No No

NA NA NA

AGNICE PRE-COMMISSIONING FORM

DIESEL ENGINE
EQUIPMENT TYPE: EQUIPMENT TAG NO.: BI/JO NO.: REF. DRAWINGS & DOCUMENTS: MANUFACTURER: MODEL NO.: COMMISSIONING DATE:
1 CERTIFICATION DOCUMENTATION RECEIVED.
2 NAME PLATE DATA CHECKED. 3 LOCATION IS PER DWG. 4 RESILIENT MOUNTING FITTED. 5 COUPLING FITTED. 6 COUPLING BOLTS FITTED. 7 COLD ALIGNMENT CHECKED. 8 DOWELS FITTED. 9 HOLDING DOWN BOLTS FITTED. 10 SHIMS MOUNTED CORRECTLY. 11 COUPLING GUARD FITTED. 12 AIR INLET FILTER INSTALLED AND ACCESSIBLE FOR MAINTENANCE. 13 EXHAUST SILENCER FITTED, INCLUDING PERSONNEL PROTECTION. 14 EXPANSION JOINTS CHECKED FOR FREE MOVEMENT. 15 LUBRICATION CHECKED (OIL TYPE___________ AND LEVEL__________). 16 NEW LUBE FILTER FITTED. 17 COOLING RADIATOR ACCESS FOR FILL AND DRAIN. 18 CRANKCASE VENT INSTALLED. 19 OIL RELIEF VENT INSTALLED. 20 INSTRUMENTS INSTALLED. 21 THEORETICAL ROTATION SAME AS DRIVEN EQUIPMENT. 22 STARTING SYSTEM CORRECT (BATTERY OR AIR SYSTEM READY FOR START). 23 COOLING SYSTEM IS CHARGED WITH THE CORRECT COOLANT MIXTURE. 24 THE GAUGE BOARD HAS BEEN CHECKED AGAINST P&ID's. 25 THE ESD STATION AND/OR THE FUEL SHUTOFF VALVES AT THE UNIT ARE OPERATIONAL. YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES

USER REFERENCE: DESCRIPTION: PLANT NO. / LOCATION:

SERIAL NO.:

NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO