WESTERN BAY OF PLENTY DISTRICT COUNCIL BUILDING CONSENT AUTHORITY
Checklists for Compliance Schedule (Inspection, maintenance and reporting procedure)
This checklist is to be completed to accompany any building consent application that
includes a new specified system or work that affects the Compliance Schedule of existing
specified system.
BC:
Site address
Building name (if known)
New Compliance Schedule is required
Compliance Schedule is amended
Existing Compliance Schedule No. (if known):
Current, lawfully established
used
Equivalent Fire Risk Group
(fire design)
Maximum occupancy
per floor (fire design)
Number of floor level
Physical location where the
Compliance Schedule will be
kept
First point of contact for
communications with the TA
(if different to owner)
Contact
person
Mailing
address
Phone
Mobile
Email
Guidance notes:
Please tick the appropriate box and provide all relevant information.
Where specific design is nominated/proposed, please provide appropriate documentation and specific design in
support of the proposed design, inspection, maintenance and reporting procedure.
What is Specified System?
Specified systems are systems or features that contribute to the proper function of the building. Specified systems
are defined in the Building (Specified Systems, Change the Use, and Earthquake-prone Buildings) Regulations 2005.
What is Compliance Schedule?
A compliance Schedule is a list of all specified system, contained in a building with details of performance standards,
inspection, testing and maintenance procedure, the frequency of inspection and show should perform the inspection;
for each specified system.
What are performance standards?
The level of performance a specified system was intended to meet, and continue to meet at the time it was designed
and installed in the building. It may be a specific approved standard, an acceptable solution or specifically designed
for the specified system.
What are maintenance standards?
This identifies what preventative and responsive maintenance is required to be taken and by whom. The details of
maintenance and inspection requirements are often found in a NZ Standard or International Standard.
What is the Compliance Schedule Handbook?
A guidance document issued by the Ministry of Business, Innovation and Employment Building and Housing Group
with helpful suggestions and recommendations for preparing, developing and implementing a Compliance Schedule
and Building Warrant of Fitness regime.
See also web link: http://www.dbh.govt.nz/compliance-documents#handbooks
A941630
Version 1
26 May 2014
Page 1 of 12
The following specified systems are contained in the building:
(Please tick the appropriate box and provide the appropriate supporting documentation where applicable)

SS1 – Automatic systems for fire suppression
Status of the specified system
System description
Location/Description
Existing
New
Type 6
Type 7
Altered
Gas/foam flooding
N/A
Removed
Deludge system
Other specific design - please state
(please state
where relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4541:2007
NZS 4541:2013
NZS 4515:2009
Other specific design - with supporting document
NZS 4541:2007
NZS 4541:2013
NZS 4515:2009
System description
NFPA 25
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS2 – Automatic or manual emergency warning systems for fire or other danger
Status of the specified system
NFPA
N/A
Existing
New
Altered
Removed
Type 2
Type 3
Type 4
Type 5
SSWS
Gas or radiation detection
Beam detection
Other specific design - please state
Location/Description
(please state
where relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4512:2003
NZS 4512:2010
NFPA
Other specific design - with supporting document
NZS 4512:2003
NZS 4512:2010
NFPA
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS3/1 – Electromagnetic or automatic doors or windows – Automatic doors
Status of the specified system
Existing
New
Automatic sliding door
System description
Altered

N/A
Removed
Automatic revolving door
Interfaced with emergency warning system
Other specific design - please state
Location/Description
(please state where
relevant)
Page 2 of 12
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4239:1993
AS 4085:1992
Other specific design - with supporting document
NZS 4239:1993
AS 4085:1992
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS3/2 – Electromagnetic or automatic doors or windows – Access controlled doors
Status of the specified system
System description
Existing
New
Altered
Swipe card access
Proximity sensor access
Key pad access
Delayed egress
N/A
Removed
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
Requirements identified in the relevant Compliance Documents C/AS1-7
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS3/3 – Electromagnetic or automatic doors or windows – Interfaced fire or smoke doors or windows
(designed to open or close on the activation of the building emergency warning system)
 N/A
Status of the specified system
Existing
Fire or smoke door
System description
New
Altered
Removed
Fire or smoke window
Electromagnetic held open door
Fusible link released type
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
SS4 – Emergency lighting systems
A941630
Version 1
26 May 2014
NZS 4520:2010
AS 4178:1994
NZS 4232:1988
Other specific design - with supporting document
AS 4178:1994
NZS 4520:2010
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

N/A
Page 3 of 12
Status of the specified system
Existing
New
Altered
Removed
Emergency lighting on escape route
System description
Illuminated exit sign
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS/NZS 2293.1:1998
NZS 6742:1971
Other specific design - with supporting document
AS/NZS 2293.2:1995
NZS 6742:1971
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS5 – Escape route pressurisation systems
Status of the specified system
Existing
New
Stairwell pressurisation
Altered
N/A
Removed
Corridor/hallway pressurisation
Lift shaft pressurisation
System description
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS 1668.1:1998
Other specific design - with supporting document
AS 1851
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS6 – Riser mains
Status of the specified system
Charged riser
System description
Location/Description
Existing
New
Altered
N/A
Removed
Dry riser
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
NZS 4510:2008
Other specific design - with supporting document
NZS 4510:2008
Other specific design - with supporting document
Page 4 of 12
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS7 – Automatic back-flow preventers
Status of the specified system
Existing
New
Altered
Reduced Pressure Zone device
N/A
Removed
Double Check Valve device
Pressure Vacumm Breaker device
System description
Atmospheric Vacuum Breaker device
Other specific design - please state
Brand/Name/Serial No./Size
(please state where relevant)
Location/Description
(please state where
relevant)
Performance standards
AS/NZS 2845.1:2010
Other specific design - with supporting document
AS 2845.3:2010
Maintenance standards
US Environmental Protection Agency "Cross-Connection Control Manual"
Other specific design - with supporting document
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS8/1 – Passenger-carrying lifts
Status of the specified system
Existing
New
Passenger lift
Altered
Removed
Platform lift
Accessible platform lift
System description
N/A
Water powered lift
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
NZS 4332:1997 and D2/AS1
NZS 4334:2012
EN 81 Part 1 and D2/AS1
EN 81 Part 2 and D2/AS1
Other specific design - with supporting document
NZS 4332:1997 and the Compliance Schedule Handbook
NZS 4334:2012 and the Compliance Schedule Handbook
Maintenance standards
EN 81:2003 and the Compliance Schedule Handbook
The Power Lift Rules applicable at the time of installation (pre 1991)
Other specific design - with supporting document
A941630
Version 1
26 May 2014
Page 5 of 12
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS8/2 – Service lifts
Status of the specified system
System description
Existing
New
Altered
Dumb waiter
Goods hoist
Vehicle stacking system
Stage lift
N/A
Removed
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
The Rule for Power Lifts Not Exceeding 750 Watts (1 HP) and D2/AS2
Other specific design - with supporting document
The Compliance Schedule Handbook checklist pages 34-35
Maintenance standards
The Rule for Power Lifts Not Exceeding 750 Watts (1 HP)
Other specific design - with supporting document
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS8/3 – Escalators and moving walks
Status of the specified system
New
Escalator
System description
Location/Description
Existing
Altered
N/A
Removed
Moving horizontal walkway
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
EN 115 and D2/AS3
Other specific design - with supporting document
The Compliance Schedule Handbook checklists page 37
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS9 – Mechanical ventilation or air conditioning systems
Status of the specified system
Existing
New
Altered
N/A
Removed
Page 6 of 12
Mechanical ventilation or air conditioning system
Extract system serving multiple units or facilities
Dust/Fume/Hazardous atmosphere extract system
A spray booth ventilation system
Parking/garage extract system
System description
Cooling-water system with cooling tower or evaporative condenser
System required to function in smoke management during a fire
System incorporating solid liquid or gas fired boiler
Air handling system that maintains a differential air pressure
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
NZS 4302:1987
NZS 4303:1990
AS/NZS 1668.1:1998
AS/NZS 4114.1:2003
AS/NZS 1668.2:2012
Other specific design - with supporting document
Maintenance standards
NZS 4302:1987
AS 1851:2005
AS/NZS 3666.3:2011
AS/NZS 4114.2:2003
AS/NZS 3666.2:2011
Cooling tower - The Compliance Schedule Handbook pages 39 and 40
Other specific design - with supporting document
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS10 – Building maintenance units
Status of the specified system
New
Access equipment
System description
Location/Description
Existing
Altered
N/A
Removed
Gantry
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
BS 6037.1:2003
BS 6037.2:2004
Other specific design - with supporting document
BS 6037.1:2003
BS 6037.2:2004
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS11 – Laboratory fume cupboards
Status of the specified system
A941630
Version 1
26 May 2014
Existing
New
Altered
N/A
Removed
Page 7 of 12
Ducted fume cupbaord for laboratory use
System description
Location/Description
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS/NZS 2243.8:2014
Other specific design - with supporting document
AS/NZS 2243.8:2014
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS12/1 – Audio loops or other assistive listening systems – Audio loops
Status of the specified system
Location/Description
Existing
New
Altered
N/A
Removed
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4121:2001 Appendix E3 and Appendix H
Other specific design - with supporting document
AS 60118.4:2007 and the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS12/1 – Audio loops or other assistive listening systems – Audio loops
Status of the specified system
Location/Description
Existing
New
Altered
N/A
Removed
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4121:2001 Appendix E3 and Appendix H
Other specific design - with supporting document
AS 60118.4:2007 and the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS12/2 – FM radio frequency system and infrared beam transmission systems
Status of the specified system
Location/Description
Existing
New
Altered

N/A
Removed
(please state where
relevant)
Page 8 of 12
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4121:2001 Appendix E3 and Appendix H
Other specific design - with supporting document
The Compliance Schedule Handbook page 43
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS13/1 – Mechanical smoke control
Status of the specified system
System description
Existing
New
Altered
Smoke exhaust/extract system
Smoke control
Zone pressurisation system
Purge system
N/A
Removed
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS/NZS 1668.1:1998
AS/NZS 1668.3:2001
Other specific design - with supporting document
AS 1851:2005
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS13/2 – Natural smoke control
Status of the specified system
New
Natural smoke ventilator
System description
Location/Description
Existing
Altered
N/A
Removed
Smoke reservoir
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS/NZS 1668.1:1998
AS/NZS 1668.3:2001
Other specific design - with supporting document
AS 1851:2005
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS13/3 – Smoke curtains
Status of the specified system
Existing
System description
Automatic smoke curtain
A941630
Version 1
26 May 2014
New
Altered
N/A
Removed
Page 9 of 12
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
Maintenance standards
Inspection and reporting
frequency
AS/NZS 1668.1:1998
AS/NZS 1668.3:2001
Other specific design - with supporting document
AS 1851:2005
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS14/1 – Emergency power systems for a specified system in any of specified system 1-13
Status of the specified system
Existing
New
Altered

N/A
Removed
Engine alternator set for a sprinkler system pressure boost pump
Uninterupted power supply for an emergency lighting system
System description
Engine alternator set for provisions of electrical supply to lifts
Emergency electric supply to smoke control system
Other specific design - please state
Location/Description
(please state where
relevant)
Performance standards
NZS 6104:1981
Other specific design - with supporting document
NZS 6104:1981
Maintenance standards
Relevant document specified for the relevant specified system SS 1-13
Other specific design - with supporting document
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS14/2 – Signs relating to specified system
Status of the specified system
Performance standards
Existing
New
Altered
N/A
Removed
Signage should be in accordance with the published standard or the
approved performance specification of the associated specified system
SS 1-13
Signage for access and facilities for person with disabilities must be in
accordance with NZS 4121:2001.
Other specific design - with supporting document
Maintenance standards
The Compliance Schedule Handbook
Other specific design - with supporting document
Page 10 of 12
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS15/1 – Systems for communicating spoken information intended to facilitate evacuation
Status of the specified system
Existing
New
Altered

N/A
Removed
A building intercom system for use by the Fire Service
A public address system to facilitate staged evacuation
System description
An emergency warning intercommunication system (EWIS)
Other specific design - please state
Performance standards
Maintenance standards
Inspection and reporting
frequency
NZS 4512:2010
AS 1670.4:2004
Other specific design - with supporting document
NZS 4512:2010
AS 1851:2005
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS15/2 – Final exits
Status of the specified system
Performance standards
Maintenance standards
Inspection and reporting
frequency
Existing
New
Altered
Removed
The relevant NZBC Compliance Documents C/AS1-7 Protection from Fire
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

SS15/3 – Fire separations
Status of the specified system
N/A
Existing
New
Altered
N/A
Removed
The relevant NZBC Compliance Documents C/AS1-7 Protection from Fire
Performance standards
NZS 4520:2010
Other specific design - with supporting document
Maintenance standards
A941630
Version 1
26 May 2014
As recommended in the Compliance Schedule Handbook
Other specific design - with supporting document
Page 11 of 12
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
SS15/4 – Signs for communicating information intended to facilitate evacuation
Status of the specified system
Performance standards
Maintenance standards
Inspection and reporting
frequency
Existing
New
Altered
Performance standards
Maintenance standards
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

Existing
New
Altered
N/A
Removed
The relevant NZBC Compliance Documents C/AS1-7 Protection from Fire
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook
Other specific design - with supporting document
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document

Existing
Cable car
System description
Location/Description
Removed
Other specific design - with supporting document
SS16 – Cable cars
Status of the specified system
N/A
The relevant NZBC Compliance Documents C/AS1-7 Protection from Fire
SS15/5 – Smoke separations
Status of the specified system

New
Altered
N/A
Removed
Ski chair lift
Other specific design - please state
(please state where
relevant)
Performance standards
Maintenance standards
NZS 5270:2005
Other specific design - with supporting document
NZS 5270:2005 and checklist page 56 of the Compliance Schedule
Handbook
Other specific design - with supporting document
Inspection and reporting
frequency
As recommended in the Compliance Schedule Handbook and the
nominated standards
Other specific design - with supporting document
Page 12 of 12