FOR FIRE BUREAU USE ONLY

Portland Fire & Rescue

Fire Marshals Office
1300 SE Gideon Street
Portland, OR 97202-2419

DATE
RECEIVED
COMPLEX #
BUILDING #

Phone: 503.823.3712
Fax: 503.823.3969

BUSINESS #
LOCATION #

CHECK SHEET FOR TEST OF

BILL TO: #

WET PIPE SPRINKLER SYSTEM

PHYS. FAC. #
APPEAL #
DATE
ENTERED

TEST DATE :
BUSINESS NAME:
BUILDING NAME:
BUILDING ADDRESS:
CONTACT:

PHONE:

Number of stories in building?

Occupied?

YES

NO

KIND OF FIRE PROTECTION SYSTEMS IN BUILDING:

Totally Sprinklered

Partially Sprinklered

Monitored by Central Station? YES

Basement Sprinklers Only

NO

Exitway Sprinklers

Name of Monitoring Company:

AUTOMATIC WET PIPE SPRINKLER SYSTEMS:

Fire Department Connection:

Swivels free from damage?

YES

NO

Check valve backflushed?

YES

NO

Number of wet pipe system risers:

Swivels operate properly?

System design proper for hazard / commodity class?

YES

NO

YES

NO

IF MORE THAN 3 RISERS, USE ADDITIONAL FORM.

Hydraulic design information on each system riser?

YES

NO

NOTE: This design sign is required for all occupancies with hydraulically designed systems.

Hydraulic Design Information

System #

Density

Appl. Area

Signs on valves? (main drain, control valve, inspectors test, etc.) YES

NO

#1

ft.

ft.

Appropriate number of spare heads and wrenches?

NO

#2

ft.

ft.

#3

ft.

ft.

YES

Date of manufacturer of sprinkler heads installed in system?

SYSTEM DESCRIPTION
2 Main drain flow test static Pressure?
Residual Pressure

System # 1

System # 2

System # 3

Areas protected with proper coverage? YES

NO

Wet piping adequately protected from freezing? YES

NO

Sprinkler heads free from paint and

unobstructed?

YES

NO

Control valves tampered or locked in

open positions?

YES

NO

Sprinkler heads proper type?

YES

NO

Pressure gauges calibrated?

YES

NO

Any dry type sprinkler heads?

YES

NO

Number dry heads removed and sent in for testing?

CHECK SHEET FOR TEST OF

WET PIPE SPRINKLER SYSTEM

PF&R # 300.26 WPS Rev. 12/07 lv

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INSPECTORS ALARM TEST:

Flowed?

YES

NO

Valve tampers activated?

YES

NO

All alarm devices operating properly?

YES

NO

Central station received proper signals? YES

NO

ANTIFREEZE SYSTEMS:
Control valves locked open or
tamper switches installed?

YES

NO

Antifreeze

Specific gravity
System protected to

REQUIRED CORRECTIONS:
1.
2.
3.
4.
5.

CORRECTIONS MADE:
1.
2.
3.
4.
5.
Has the building owner / representative been notified of any deficiencies?

YES

NO

If YES, who was notified?

If NO, why wasnt the owner / representative notified?

Certified Personnel Conducting Test (PLEASE PRINT NAME)

Certification #

Signature:

Name of Company:

Phone:
QUESTIONS? CALL 503-823-3712

PF&R # 300.26 WPS Rev. 12/07 lv

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