FIRE WINDOW Form 17-E

Quarterly and Annual Tests and Inspection

Year System

Location

Test Emergency Operation Quarterly

Date Person Conducting Test Test Results

1st Quarter Date:
2nd Quarter Date:
3rd Quarter Date:
4th Quarter Date:
Verify the Following Annually

Date Inspector

1. Inspect rigging system to ensure it is properly supported, in good condition, and will operate properly.

Rigging inspection should be performed by qualified person.

2. Record any repairs and maintenance below.

3. Retrain the manger and staff on emergency operation of the curtain. List all those attending training below.

Note: Use reverse side for comments.