Safety Detector Inspection Form

Safety Detector Inspection Form

Inspection Parties & Site

Inspection Date:   Start Time:   End Time:

Agreement Recitals

WHEREAS, Inspector represents that it is qualified and experienced in performing safety inspections of detectors and related life-safety devices; and

WHEREAS, Client has engaged Inspector to perform an inspection of detectors at the site identified above and to report findings and recommended corrective actions; and

NOW, THEREFORE, in consideration of the mutual covenants contained herein, Inspector and Client agree as follows: the inspection described in this form will be performed in accordance with the Scope of Work and the terms set forth below.

Scope of Work

The Inspector shall perform a systematic visual and functional inspection of detectors listed on this form and any additional devices noted in attachments. Inspection services include verification of device location, identification of device type and serial number, evaluation of power and battery status, operational testing where safe and appropriate, and documentation of deficiencies and recommended corrective actions. The Inspector will not disassemble, alter or install equipment unless separately authorized in writing.

Inspection Checklist: Detector Inventory

Instructions: For each device inspected, document location, type, serial number, manufacture date, power/battery status, and test result. Use additional sheets if needed.

Device 1 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Device 2 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Device 3 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Device 4 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Device 5 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Device 6 — Location:   Type:   Serial #:

Manufacture Date:   Battery Status:   Operation Test:

Attachments Included: Report Photos

Payment Terms

Total Fee:   Deposit Required:

Late Fee:

Term and Termination

Agreement Start Date:   Agreement End Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered no fewer than days prior to the effective termination date. Termination for cause may occur immediately where a material breach remains uncured following a 10-day cure period.

Confidentiality

Inspector and Client shall maintain in confidence all non-public information disclosed in connection with the inspection and this Agreement. Confidential information shall not be disclosed to third parties except as required by law or to perform the services, and in such cases the disclosing party shall provide prior notice where feasible. Confidentiality obligations shall survive termination for a period of years.

Limitation of Liability & Certification

Inspector will perform the inspection with reasonable care using industry-standard practices. Inspector does not warrant the future performance of devices beyond the observations documented at the time of inspection. Except for willful misconduct or gross negligence, Inspector's total liability arising from or related to this Agreement shall be limited to the fees paid for the inspection services.

Inspector certifies that the inspection documented herein was performed by qualified personnel and that the information provided reflects the inspector's professional observations as of the inspection date.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to choice-of-law principles.

Entire Agreement

This form, together with any attachments or written amendments signed by both parties, constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior communications, proposals, and agreements, whether oral or written. Any modification must be in writing and executed by both parties.

Inspector Certification and Notes

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