INTERFACE COMPONENT

SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

This form is a supplement to the System Record of Inspection and Testing.
It includes an interface component test record for circuit interfaces, signaling line circuit interfaces, and fire alarm
control interfaces.
This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or
test.
It shall be permitted to modify this form as needed to provide a more complete and/or clear record.
Insert N/A in all unused lines.
Inspection/Test Start Date/Time: 2/11/2017 Inspection/Test Completion Date/Time: 2/11/2017

Number of Supplemental Pages Attached: 1

1. PROPERTY INFORMATION

Name of property: B+G+3 RESIDENTIAL APARTMENTS

Address: MATAR KHADEEM ,DOHA QATAR - AREA 45 - STREET 976, AL HUSEIN BIN ALI STREET

2. INTERFACE COMPONENT TEST RESULTS

Interface Component Type Address Location Test Results

fire fighting Ref to attched point basement 1 to roof Ok
(pumps/valves/flowswitch) list
Lifts Ref to attched point Roof Ok
list
Generator Ref to attched point Basement Ok
list
exhaust Fans Ref to attched point Basement Ok
list
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       

Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.

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 INTERFACE COMPONENT
SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued)

2. INTERFACE COMPONENT TEST RESULTS (continued)

Interface Component Type Address Location Test Results

                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       

See main System Record of Inspection and Testing for additional information, certifications, and approvals.

Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.

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