FSM3/ C. EXTENT OF THE INSTALLATION AND LIMITATIONS OF THE INSPECTION AND SERVICING

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1 A. DETAILS OF THE CLIENT Client: Address: B. DETAILS OF THE FIRE DETECTION AND ALARM SYSTEM Address: Details of the system: FSM3/ FIRE DETECTION AND ALARM SYSTEM INSPECTION AND SERVICING REPORT D. CERTIFICATION OF INSPECTION AND SERVICING I/we being the competent person(s) responsible (as indicated by my/our signatures below) for the inspection and servicing of the fire alarm system, particulars of which are set out above, CERTIFY that the said work for which I/we have been responsible complies to the best of my/our knowledge and belief with the recommendations of Clause 45 of BS : 2002 quarterly inspection of vented batteries/periodic inspection and test/inspection and test over a 12 month period (delete as applicable), except for the variations, if any, stated in this report. Variations from the recommendations of Clause 45 of BS : 2002 for periodic or annual inspection and test (as applicable): The extent of liability of the signatory is limited to the system described above. For the INSPECTION and SERVICING of the system: E. PARTICULARS OF THE ORGANIZATION RESPONSIBLE FOR THE INSPECTION AND SERVICING Organisation: Postcode: Postcode: C. EXTENT OF THE INSTALLATION AND LIMITATIONS OF THE INSPECTION AND SERVICING Extent of the fire detection and alarm system covered by this report: Agreed limitations, if any, on the inspection and servicing: I/we further declare that in my/our judgement, the said system was overall in servicing was carried out, and that it should be further inspected as recommended (see H). Name: (CAPITALS) Continue on additional numbered pages as required condition (see G) at the time the inspection and (Insert a satisfactory or an unsatisfactory as appropriate) Position: Signature: Date: Original (To the person ordering the work) Address: Postcode: This form is based on the model in Appendix G6 of BS 5839: Part 1: Copyright The Electrical Safety Council (Jan 2008). FSM3/1 Please see the Notes for Recipient on the reverse of this page. Page 1 of

2 NOTES FOR RECIPIENT THIS REPORT IS AN IMPORTANT AND VALUABLE DOCUMENT WHICH SHOULD BE RETAINED FOR FUTURE REFERENCE This report has been issued to confirm that the fire detection and alarm system to which it relates has been inspected and serviced in accordance with the recommendations given in BS 5839 Fire detection and fire alarm systems for buildings - Part 1: Code of practice for system design, installation, commissioning and maintenance. It is essential that the fire detection and alarm system is subject to periodic inspection and servicing so that: unrevealed faults are identified preventative measures can be taken to ensure the continued reliability of the system false alarm problems are identified and suitably addressed and the User(s) and the Responsible Person are made aware of any changes to the building that affect the protection afforded by the system. It is also essential that the routine testing which includes both weekly testing and monthly attention as detailed in Clauses 44.2 and 44.3 of BS : 2002 is performed by the Responsible Person. In addition, as indicated in Section H (Next Inspection and Servicing), the Responsible Person should ensure that, as recommended in BS : 2002, the system is inspected and serviced by a competent person at least at quarterly, six-monthly and annual intervals as appropriate and that the results are recorded on Fire Detection and Alarm System Inspection and Servicing Reports and that appropriate action is taken to correct any recorded defects. It remains the responsibility of the compiler of the report to ensure that the information provided on the report is factual, and that the declaration (in Section D) of the overall condition of the fire detection and alarm system to which the report relates is reasonable in all the circumstances. The fire detection and alarm system Periodic inspection and servicing needs to be carried out by a competent person with specialist knowledge of fire detection and alarm systems, including knowledge of the causes of false alarms, sufficient information regarding the system, and adequate access to spares. Persons offering to design, install, commission, accept, verify, modify, maintain or inspect and service fire detection and alarm systems have a duty in law to ensure that all their supervisors and operatives given responsibility for such work are competent. This includes having a full understanding of all the technical and operational requirements relating to fire detection and alarm systems and, if appropriate, being competent in battery installation and maintenance technology. This will normally be an outside fire alarm servicing organization. Care needs to be taken to ensure that, if, for example, in-house employees are used for this task, they have equivalent competence to the technicians of a fire alarm servicing organization. Competence of fire alarm servicing organizations can be assured by the use of organizations that are third-party certificated, by a UKAS-certificated certification body, to carry out inspection and servicing of fire detection and alarm systems. This fire detection and alarm system inspection and servicing report This report is intended for use by fire detection and alarm system engineers not enrolled with NICEIC, or by NICEIC Approved Contractors working outside the scope of their enrolment. This report has been adapted from BS : 2002 with the permission of BSI under licence number 2002SK/0342. Complete British Standards can be obtained from BSI Customer Services, 389 Chiswick High Road, London, W4 4AL. FSM3/1&2B Copyright The Electrical Safety Council (Jan 2008) continued on the reverse of page 2

3 FSM3/ F. OBSERVATIONS AND RECOMMENDATIONS FOR ACTIONS TO BE TAKEN Referring to the attached schedules of inspection and testing results, and subject to the limitations at C: There are no items adversely affecting operational performance of the fire detection and alarm system or The following observations and recommendations are made Item No 1 Please see the reverse of this page for guidance regarding the Recommendations. Urgent remedial work recommended for Items: This form is based on the model in Appendix G6 of BS 5839: Part 1: Copyright The Electrical Safety Council (Jan 2008). Corrective action(s) recommended for Items: Recommendation Code Note: If necessary, continue on additional numbered page(s). Where observations are made, the inspector will have entered one of the following codes against each observation to indicate the action (if any) recommended:- 1. requires urgent attention or 2. requires improvement or 3. requires further investigation or 4. does not comply with BS G. SUMMARY OF INSPECTION AND SERVICING See note below General condition of the fire detection and alarm system: Outstanding defects reported to responsible person H. NEXT INSPECTION AND SERVICING Based upon risk assessment, taking into account the type of system and the environment, I RECOMMEND that the fire detection and alarm system, details of which are given on page 1 of this certificate, is inspected and serviced after a period not exceeding: Date(s) of the inspection and servicing: Relevant details of the work carried out and faults identified have been entered in the system log book. (see Clause 40.2) During the past 12 months, false alarms have occurred. This number of false alarms equates to false alarms per 100 automatic fire detectors per annum All boxes must be completed FSM3/3 Continue on additional numbered pages as required (for Category M systems enter Not Applicable ). weeks/months Enter a period not exceeding 6 months Please see the Notes for Recipient on the reverse of this page. Page 2 of Original (To the person ordering the work)

4 NOTES FOR RECIPIENT (continued from the reverse of page 1) GUIDANCE ON THE RECOMMENDATION CODES Only one Recommendation Code should have been given for each recorded observation. Recommendation Code 1 Where an observation has been given a Recommendation Code 1 (requires urgent attention), the safety of those using the building may be at risk. The Responsible Person is advised to take action without delay to remedy the observed deficiency in the system, or to take other appropriate action to restore the system to a fully operational condition. The Contractor issuing this report will be able to provide further advice. It is important to note that the recommendation given at Section H (Next Inspection and Servicing) of this report for the maximum interval until the next inspection and servicing, is conditional upon all items which have been given a Recommendation Code 1 being remedied without delay. Recommendation Code 2 Where an observation has been given a Recommendation Code 2 (requires improvement), the Responsible Person is advised that, while the safety of those using the building may not be at immediate risk, remedial action should be taken as soon as possible to improve the operational condition of the system to a level which affords compliance with BS The Contractor issuing this report will be able to provide further advice. Items which have been attributed Recommendation Code 2 should be remedied as soon as possible (see Section F). Recommendation Code 3 Where an observation has been given a Recommendation Code 3 (requires further investigation), the inspection has revealed an apparent deficiency which could not, due to the extent or limitations of this inspection, be fully identified. Items which have been attributed Recommendation Code 3 should be investigated as soon as possible (see Section F). The Responsible Person is advised to arrange for the NICEIC Approved Contractor issuing this report (or, if appropriate, the manufacturer of the equipment or another competent person) to undertake further examination of the installation to determine the nature and extent of the apparent deficiency. Recommendation Code 4 Recommendation Code 4 (does not comply with BS ) will have been given to observed non-compliance(s) with the current safety standard which do not warrant one of the other Recommendation Codes. It is not intended to imply that the fire detection and alarm system is not in an operational condition, but careful consideration should be given to the benefits of improving these aspects of the installation. The Contractor issuing this report will be able to provide further advice. FSM3/3&4B Copyright The Electrical Safety Council (Jan 2008) continued on the reverse of page 3

5 J. SCHEDULE OF ITEMS INSPECTED Manual call points suitably sited Manual call points are unobstructed Manual call points are conspicuous FSM3/ I. QUARTERLY INSPECTION OF VENTED BATTERIES See note below Batteries checked All exits, including any new exits, have manual call points Automatic fire detectors suitable for building use or occupancy Automatic fire detectors suitably sited Fire alarm devices suitably sited No partitions within 500 mm horizontally of any automatic fire detector (Clause 22.3g) No storage within 300 mm of ceilings (Clause 22.3i) Clear space of 500 mm exists below each automatic fire detector (Clause 22.3n) Each automatic fire detector s ability to receive the stimulus it is designed to detect has not been impeded by any other means See note below Premises Note that structural or occupancy changes may have affected compliance with BS K. SCHEDULE OF ITEMS TESTED Fire alarm functions of CIE checked by operation of at least one detector or manual call point in each circuit and entry made in log book indicating which initiating devices used for these tests Operation of fire alarm devices Controls and visual indicators at CIE checked for correct operation Ancillary functions of CIE tested For CIE, manufacturer s checks and tests performed Fault indicators and their circuits checked by simulation of fault conditions Automatic transmission of alarm signal to receiving centre Automatic transmission of other signals, such as fault signals, to receiving centre Battery connections checked See note below Building use or occupancy does not make existing types of automatic fire detector unsuitable for detection of fire or prone to unwanted alarms Additional fire detection and alarm equipment provided in any extensions or alterations to the building Documentation System log book examined Any faults recorded have been attended to False alarms Continue on additional numbered pages as required Record of false alarms checked in accordance with Clause 30.2i Rate of false alarms during the previous 12 months recorded (Clause 30.2i) Action taken in respect of false alarms complies with the recommendations of Clause 30.2j: Radio systems serviced in accordance with manufacturer s recommendations For other equipment, manufacturer s checks and tests performed Printers checked for correct operation Printers checked that characters are legible Electrolyte levels checked and topped up as necessary Printer consumables available in sufficient quantity to ensure operation until next service visit Standby battery disconnected and full load alarm simulated Specific gravity of each cell of vented batteries checked Mains disconnected and batteries momentarily load tested (other than those within devices such as manual call points, detectors and fire alarm sounders of a radio linked system) L. ARRANGEMENTS IN PLACE FOR REPAIR OF FAULTS OR DAMAGE See note below Emergency call out arrangement in place where maintenance carried out by a third party User records faults or damage in log book Original (To the person ordering the work) Name and telephone number of any third party responsible for maintenance prominently displayed at main CIE Records and documentation give information on maintenance arrangements. See Clause 40 All boxes must be completed indicates that an inspection or a test was carried out and the result was satisfactory indicates that an inspection or a test was carried out and the result was unsatisfactory. This form is based on the model in Appendix G6 of BS 5839: Part 1: Copyright The Electrical Safety Council (Jan 2008). FSM3/5 User arranges for repairs to be carried out as soon as possible N/A indicates that an inspection or test was Not Applicable. LIM indicates that, exceptionally, a limitation agreed with the person ordering the work prevented the inspection or test being carried out. Please see the Notes for Recipient on the reverse of this page. Page 3 of

6 NOTES FOR RECIPIENTS (Continued from the reverse of page 2) This report is intended to be issued only for the inspection and servicing of a fire detection and alarm system. This report consists of at least four numbered pages and should be read in conjunction with the documents identified in Section P Related Reference Documents on the report. It is part of a suite of documentation identified on page 4 of the report to be provided to you, the Recipient, and it should be passed to the User and/or the Responsible Person for the system. You should have received the report marked Original and the organization responsible for inspecting and servicing the fire detection and alarm system should have retained the report marked Duplicate. This report is a valuable document and should be retained for future reference as you may, subsequently, rely on this report as evidence of compliance with legislation. If you were the person ordering the work but not the User of the system, you should pass this report, or a full copy of it including all the related reference documents immediately to the User and/or the Responsible Person. The Original report should be retained in a safe place and shown to persons responsible for inspecting, servicing, modifying or using the fire detection and alarm system. If you later vacate the property or building this inspection and servicing report will demonstrate to the new Responsible Person that the fire detection and alarm system was inspected and serviced as recommended by BS The Responsible Person The Responsible Person referred to in these Notes for Recipient is defined in BS as: The person having control of the building and/or premises, whether as occupier or otherwise, or any person delegated by the person having control of the building and/or premises to be responsible for the fire alarm system and the fire procedures. The User The User referred to in these Notes for Recipient is defined in BS as: The person or organization having control of the building (or part of the building) in which the fire detection and alarm system is installed. Completing the report Page 1 Sections A and B: Details of the Client and Details of the Fire Detection and Alarm System Information presented in the boxes should clearly identify the Client and the location and extent of the fire detection and alarm system. Section C: Extent of the Installation and Limitations of the Inspection and Servicing should fully identify the extent of the system covered by the report and any agreed limitations on the inspection and servicing. The Contractor should have agreed all such aspects with the Responsible Person and other interested parties (eg licensing authority, insurance company, building society) before carrying out the inspection and servicing. It would be reasonable to assume that comprehensive inspection and servicing of the whole of the fire detection and alarm system, without limitations, has been carried out unless otherwise clearly indicated in this Section. It should be noted that the greater the limitations applying to an inspection and servicing, the less the value of the fire detection and alarm system inspection and servicing report. Section D: Certification of Inspection and Servicing The contractor should have signed and dated the report and recorded any variations which should have been agreed by all interested parties and recorded in the box provided. A one-word overall assessment of the installation ie satisfactory or unsatisfactory should be made in this Section of the report, reiterating the summary given in Section G which should summarise the observations and recommendations made in Section F. Section E: Particulars of the Organization Responsible for the Inspection and Servicing The Contractor should have given the required details. Page 2 Section F: Observations and Recommendations for Actions to be Taken includes two boxes at the top, in one of which the report compiler should have entered a Yes or a to indicate, as appropriate, that there are no items adversely effecting operational performance of the fire detection and alarm system or the following observations and recommendations are made. In the latter case, the observations and recommendations for urgent remedial work and corrective action(s) necessary to maintain the installation in a safe working order should have been given and are to be listed with a Recommendation Code 1, 2, 3 or 4 (see reverse of page 2 of the report form for further guidance on the recommendations). Only one Recommendation Code is to be given for each recorded observation. At the bottom of the Section, two boxes are provided for recording the items which, in the opinion of the report s compiler, need urgent remedial work and those items requiring corrective action, respectively. Where a Contractor classifies a recommendation as requires urgent attention, the client is to be advised immediately, in writing. It should be noted that, where an existing or a potential defect is observed that may put the safety of those using the building at risk, Recommendation Code 1 (requires urgent attention) must be used. If the space available on the form for recording recommendations is insufficient, additional numbered pages are to be provided as necessary. continued on the reverse of page 4 FSM3/5&6B Copyright The Electrical Safety Council (Jan 2008)

7 FSM3/ M. OVER A 12 MONTH PERIOD - SCHEDULE OF ITEMS INSPECTED Premises Automatic fire detectors unpainted Automatic fire detectors undamaged Visual fire alarm devices not obstructed Lenses of visual fire alarm devices are clean Readily-accessible cable fixings secure Readily-accessible cable fixings undamaged Documentation N. OVER A 12 MONTH PERIOD - SCHEDULE OF ITEMS TESTED Switch mechanism of every manual call point Fire alarm devices checked for correct operation Automatic fire detectors functionally tested, including heat detectors, point smoke detectors, optical beam smoke detectors, aspirating fire detection systems, carbon monoxide fire detectors, flame detectors and multi-sensor detectors All unmonitored, permanently-illuminated filament lamp indicators at CIE replaced See note below Cause and effect programme confirmed as being correct See note below CIE manufacturer s annual checks and tests carried out Radio signal strengths checked for adequacy For fire detection systems that enable analogue values to be determined it should be confirmed that each analogue value is within the range specified by the manufacturer Standby power supply capacity checked Checks recommended by manufacturers of other components of system carried out O. ADDITIONAL CHECKS UPON CHANGE OF SERVICING ORGANIZATION See note below Adequate number of call points (Clause 20.2) Adequate provision of fire detection for the category of system Sound pressure levels comply with Clause 16.2 Changes in use, layout or construction of the premises have not reduced system effectiveness Cabling has fire resistance complying with Clause 26.2 Circuits monitored in compliance with Clause 12.2 Requirements of BS 7671 are met (Clause 29) P. RELATED REFERENCE DOCUMENTS Design Specification Ref No: Design Drawings Ref Nos: As Fitted Drawing Nos: Electrical Installation Fire Alarm Design Fire Alarm Installation Standby power supplies provided Standby power supplies comply with Clause 25.4 Exposure to false alarms is not excessive (see Section 3) Experience of false alarms is not excessive (see Section 3) Existing records checked Log book available. (If not available, a suitable log book should be provided by the servicing organization). (see Clause 48.2) Date issued: Date issued: Fire Alarm Commissioning Fire Alarm Verification Operating and maintenance instructions: Previous inspection and servicing report Log book: Other: Original (To the person ordering the work) All boxes must be completed indicates that an inspection or a test was carried out and the result was satisfactory. indicates that an inspection or a test was carried out and the result was unsatisfactory. N/A indicates that an inspection or test was Not Applicable. LIM indicates that, exceptionally, a limitation agreed with the person ordering the work prevented the inspection or test being carried out. This form is based on the model in Appendix G6 of BS 5839: Part 1: Copyright The Electrical Safety Council (Jan 2008). FSM3/7 Page 4 of

8 Section G: Summary of Inspection and Servicing This report should have been used to report on the inspection and servicing process, the purpose of which is to establish that the system complies with the recommendations of BS (except for any variations which should be recorded in the box entitled Certification of Inspection and Servicing). An accurate description of the general condition of the installation should have been given by the Contractor in this Section G of the report which should summarise the observations and recommendations made in Section F. If the space available on the form for the summary of the inspection and servicing is insufficient, additional numbered pages are to be provided as necessary. Section H: Next Inspection and Servicing. The period between successive inspection and servicing visits should be based on a risk assessment, taking into account the type of system installed, the environment in which it operates and other factors which may affect the long term operation of the system. The recommended period between successive inspection and servicing visits should not exceed six months. If a risk assessment shows a need for more frequent inspection and servicing visits, then all interested parties should agree the appropriate inspection and servicing schedule. If this recommendation is not implemented, it should be considered that the system is no longer compliant with Section 6 of BS Pages 3 and 4 Sections I, J, K, L, M, N and O. All boxes in the Sections I, J, K, L, M, N and O should have been completed, as appropriate, for the particular fire detection and alarm system. A should have been inserted to indicate that an inspection or test has been carried out and that the result is satisfactory. A should have been inserted to indicate that an inspection or test has been carried out and that the result is unsatisfactory. Where a has been entered which indicates a non-compliance, a departure from BS 5839 should have been recorded in Section F as an observation. N/A should be recorded in the box if an inspection or a test is not applicable. (It is unlikely that all items will apply, and the range of applicable inspections and tests will depend on the particular system covered by the report). LIM should be recorded in the box where, exceptionally, an agreed limitation has prevented the inspection or servicing being carried out. Where a limitation on a particular inspection or test has been agreed with the client, it should be recorded in Section C. Section I: Quarterly Inspection of Vented Batteries should have been completed by a person competent in battery installation and maintenance technology. Section I should be completed every quarter for fire detection and alarm systems employing vented batteries. Sections J and K: Schedule of Items Inspected and Tested should normally be completed every six months or less. (See Section H). Section L: Arrangements in place for Repair of Faults or Damage. Where maintenance is carried out by a thirdparty, such as a fire alarm maintenance organization, there should be an agreement for emergency call out to deal with any fault or damage that occurs to the system. The agreement should be such that, on a 24 hr basis, a technician of the maintenance organization can normally attend the premises within eight hours of a call from the User. (Note that this might not be possible in very remote areas and certain offshore islands, in which case this should be recorded as a variation from the recommendations of BS 5839 in respect of maintenance arrangements). This variation should be recorded in the system log book. Sections M and N: Over a 12 Month Period - Schedule of Items Inspected and Tested. In addition to the work recommended in Sections I, J and K, it is recommended that the work detailed in Sections M and N is carried out over every 12 month period. Section O: Additional Checks upon Change of Servicing Organization. When a servicing organization takes over the servicing arrangements for an existing system, a special inspection should be carried out, and existing records (see Clause 40), where available should be studied to obtain sufficient information to be documented for effective future servicing of the system. Section P: Related Reference Documents All relevant documentation should have been handed over to you the Recipient and it should be passed to the Responsible Person for the system. Provision is made for recording the details of the previous Fire Detection and Alarm System Inspection and Servicing report. A log book for the system should be available, should be held in a safe place, should be kept up to date by the Responsible Person and made available together with the other system documentation for inspection when required. FSM3/7&8B Copyright The Electrical Safety Council (Jan 2008)