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Smoke Detector 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, Smoke Detector 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. Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards. Here is some sample content from Smoke Detector Test Form:
| | SMOKE DETECTOR TEST
Date:
Quarter:
Tested By:
Zone
Detector 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
Yes No
Yes No
Yes No
Each detector in each zone is tested at least annually.
All No Answers Must Be Addressed Under Remarks
Remarks:
Reference #1025 Life... |
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