PRE-TEST SHEET
FIRE LIFE SAFETY
JOB ADDRESS
INSPECTION RECORDS AND PLANS MUST BE AVAILABLE WHEN REQUESTED
NOTE: 1. All items below that pertain to the area(s) being tested shall be checked, verified, initialed and dated by the installer responsible
for the installation. All other items shall have N/A placed in it's applicable box.
2. The Building Inspector for the project must be called and perform their Final Building Inspection prior to scheduling the Fire Life
Safety Test.
3. Electrical Inspector must perform a final electrical inspection of the fire alarm system prior to LAFD fire alarm test.
FIRE ALARM - LIFE SAFETY CONTRACTOR
APPROVED PLANS AND PERMIT
SIGN
DATE
COMPONENTS SUPERVISION / NFPA 72
/
/
COMPLETE ALL CONSTRUCTION
SIGN
DATE
/
/
/
/
DATE
/
/
SIGN
DATE
/
/
SIGN
DATE
/
/
VOICE / FIRE TONE 15 dBA ABOVE AMBIENT
DATE
/
/
SIGN
A/C SHUTDOWN
DATE
/
/
SUBSEQUENT ALARM ACTIVATION
CONTROL PANEL STATUS
FIRE RATED PENETRATIONS
SIGN
BUILDING COMMUNICATION
DATE
DEVICE ANNUNCIATION
FIRE RATED CONSTRUCTION
SIGN
SIGN
SIGN
DATE
/
SIGN
DATE
DATE
/
/
DATE
/
/
DATE
/
/
DATE
/
/
DATE
/
/
STAIRWELL PRESSURIZATION
/
/
SIGN
SPECIAL EXTINGUISHING / PRE ACTION SYSTEM
BUILDING, AUXILIARY AND OUTSIDE AIR
SIGN
SIGN
DATE
/
/
FIRE DAMPER OPERATION
SEQUENCE OF OPERATION VERIFICATION
/
SIGN
SIGN
DATE
INITIATING DEVICE(S) TESTED
STROBE LOCATION, CANDELA / NFPA 72, ADA
ELECTRIC DOOR LOCKING PER LAFD
LOCATION OF DEVICE(S) TO BE VERIFIED BY LAFD
LOCATION OF DEVICE(S) SHALL BE VERIFIED BY LAFD
SIGN
DATE
/
/
/
/
/
/
SIGN
ELEVATOR RECALL
SIGN
ELECTRICAL CONTRACTOR
APPROVED PLANS AND PERMIT
SIGN
DATE
/
/
COMPLETE ALL CONSTRUCTION
SIGN
DATE
FIRE RATED CONSTRUCTION / PENETRATIONS
ELECTRIC DOOR LOCKING PER LAFD
SIGN
SIGN
DATE
/
/
DATE
/
/
EXIT SIGN CIRCUITRY
/
/
DATE
EXIT SIGN(S) TESTED
EXIT PATH VERIFICATION
EMERGENCY LIGHTING TESTED
SIGN
LOCATION OF EXIT LIGHTING SHALL BE VERIFIED BY LAFD
SIGN
LOCATION OF LIGHTING SHALL BE VERIFIED BY LAFD
DATE
/
/
DATE
/
/
DATE
/
/
DATE
/
/
DATE
/
/
DATE
/
/
MECHANICAL CONTRACTOR
APPROVED PLANS AND PERMIT
SIGN
DATE
FIRE RATED PENETRATIONS
/
/
COMPLETE ALL CONSTRUCTION
SIGN
DATE
/
/
DATE
/
/
SIGN
/
/
SIGN
DATE
/
/
STAIRWELL PRESSURIZATION
DATE
/
/
DATE
/
/
A/C SHUTDOWN
SIGN
FIRE DAMPER OPERATION
BUILDING, AUXILIARY AND OUTSIDE AIR
DATE
CONTROL PANEL STATUS
FIRE RATED CONSTRUCTION
SIGN
SIGN
SIGN
SIGN
OTHER
DATE
/
/
DATE
/
/
/
/
SMOKE EVAC
SIGN
OTHER
SIGN
SIGN
GENERAL CONTRACTOR
APPROVED PLANS AND PERMIT
SIGN
DATE
/
/
COMPLETE ALL CONSTRUCTION
SIGN
DATE
FIRE RATED CONSTRUCTION / PENETRATIONS
FIRE DOOR INSTALLATION / NFPA 80
SIGN
SIGN
DATE
/
/
RATED DOOR HARDWARE / LABEL
/
/
TOTAL NUMBER OF LIFE SAFETY DEVICES TO
SIGN
DATE
DOOR DROP / LATCH
EVACUATION SIGNAGE
DATE
/
/
VERIFIED BY GENERAL CONTRACTOR (NAME)
SIGN
SIGN
OTHER
DATE
/
/
LAFD INSPECTOR NAME / PHONE #
SIGN
LIFE SAFETY PERMIT NUMBER
BE TESTED
SIGN
DATE
/
/
FIRE-WARNING SYSTEM PRE TESTED BY
SIGN
DATE
SIGN
DATE
/
/
VERIFIED BY BUILDING REPRESENTATIVE
/
/
(CITY USE ONLY)
SIGN
DATE
(CITY USE ONLY)
/
JOB PHONE
/
(CITY USE ONLY)
FIRE ALARM WIRING COMPLETED
ELECTRICAL INSPECTOR SIGNATURE
(CITY USE ONLY)
(CITY USE ONLY)
BUILDING FINAL INSPECTION CONDUCTED
(Correction May Be Pending)
DATE
/
/
BUILDING INSPECTOR SIGNATURE
DATE
/
/
NOTE: BOTH SIDES OF THIS FORM MUST BE FILLED OUT IN ITS ENTIRETY PRIOR
TO CALLING FOR LIFE SAFETY INSPECTION.
Permit fees provide for a limited number of inspections. A reinspection fee may be assessed for each inspection when the work for which the inspection
was requested is not completed, when inspection records or plans are not available, or there is a failure to provide access.
As a covered entity under Title II of the Americans with Disabilities Act, the City of Los Angeles does not discriminate on the basis of disability and, upon
request, will provide reasonable accommodation to ensure equal access to its programs, services and activities.
IN.Form.06 (Rev. 03-29-2016)
Page 1 of 2
www.ladbs.org
DEVICE
IN.Form.06 (Rev. 03-29-2016)
ADDRESS
DESCRIPTION
Page 2 of 2
RESULT
COMMENTS
www.ladbs.org