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Pull Station Test Form |
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Manual: Life Safety and Interim Life Safety Management Manual (Ver 4) External Reference: (JCAHO EC.5.10, EC.5.40)
MCN’s customizable template, Pull Station Test Form, is taken from our Life Safety and Interim Life Safety Management Manual. MCN Healthcare’s proven policy and procedure templates, competencies and compliance tools have assisted more than 20,000 health care organizations worldwide meet their regulatory compliance goals. MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch. Here is some sample content from Pull Station Test Form:
| | PULL STATION TEST
Date:
Quarter:
Tested By:
Zone
Station Location
PM Visual Inspection Completed By
Alarm Activated
Annunciator
Fire Doors Closed
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes ... |
| Second excerpt: |
| | ... No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Each pull station in each zone is tested at least annually.
All No Answers Must Be Addressed Under Remarks
Remarks:
Reference #1028 Life... |
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Back to Life Safety and Interim Life Safety Management Manual (Ver 4) |
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