Facility Engineering Information Forms and Reports
- Contractor's Material and Test Certificate for Aboveground Piping - 2002 Edition Installation of Sprinkler Systems, NFPA 13 Section 16.1. Must be completed upon installation of an automatic sprinkler system.
- Contractor’s Material and Test Certificate for Underground Piping - 2002 Edition Installation of Sprinkler Systems, NFPA 13 Section 10.10.1. Must be completed to document testing of the underground piping serving the automatic sprinkler system.
- Contractor’s Material and Test Certificate for Aboveground Piping - 2002 Edition Installation of Sprinkler Systems, NFPA 13R Section 6.2.1. Must be completed upon installation of an automatic sprinkler system.
- Fire Alarm System Record of Completion - 2002 Edition National Fire Alarm Code NFPA 72 Section 4.5.2. Must be completed upon installation of an fire alarm system.
- Emergency and Standby Power Systems Installation Acceptance - 2002 Edition Emergency and Standby Power Systems, NFPA 110 Section 7.13. Must be completed to verify testing of emergency and standby power systems.
- Natural Gas Systems Inspection, Testing, and Purging - 2002 Edition National Fire Gas Code, NFPA 54 Section 7.1.4. Must be completed after installation of natural gas piping.
- Medical Gas Systems Installer Performance Testing - 2002 Edition Health Care Facilities, NFPA 99 Section 18.104.22.168. Must be completed by the plumbing contractor after installation of medical gas piping, but prior to tests listed in 22.214.171.124.
- Disinfection of Potable Water System - 2003 Uniform Plumbing Code, Section 609.9. Must be completed by the plumbing contractor after installation of domestic water piping and fixtures.
- Medical Gas Piping Test 2002 Edition Health Care Facilities, NFPA 99 Section 126.96.36.199. This system verification test is completed by the medical gas testing company. A report supplied by the testing company must be completed to verify testing of medical gas piping in health care facilities in accordance with 188.8.131.52.
- Health Care Facility Fire Incident Report - Used to report a fire incident in health care facilities.
- Drill Report - Fire – Tornado – Other. Used to document fire or tornado drills conducted in health care facilities.
- Battery Smoke Detector Test Log - Centers for Medicare and Medicaid Services S&C-05-25, dated April 14, 2005. Used to document weekly function test of battery-powered smoke detectors.
- Fire Alarm and Automatic Sprinkler System Out of Service Policy - 2012 Edition Life Safety Code, NFPA 101 Section 184.108.40.206 & 220.127.116.11. Used as a policy when the fire alarm or automatic sprinkler systems are out of service for more than 4 hours in a 24 hour period.
- Emergency Lighting Test Log - 2000 Edition Life Safety Code, NFPA 101 Section 7.9.3. Used to document monthly and yearly functional test of battery-powered emergency lighting systems. (back to top)
These documents may be used to develop a preventive maintenance checklist.
- Daily Preventative Maintenance Activities
- Weekly Preventative Maintenance Activities
- Monthly Preventative Maintenance Activities
- Quarterly Preventative Maintenance Activities
- Semi-annual Preventative Maintenance Activities
- Annual Preventative Maintenance Activities
- Preventative Maintenance Activities - 2, 3, 4, 5, 6, 10 and 12 year preventive maintenance activities.
- Prior to Heating Season / Cooling Season Preventative Maintenance Activities
- Work Order (back to top)
These documents may be used to develop a housekeeping program checklist.