Valve Inspection Report Format







Main Operating Valve Water Drainage (pumped out if non-draining) Lower Stem Standpipe/Shoe Assembly. If you are offering security services which include fire alarm devices, you can use this fire alarm system report form template to monitor, inspect, test and evaluate all the fire alarm system devices you have. Sample - Compressed Gas Cylinder Inspection Checklist. OQ Plan and Records Inspection; Operator Qualification Field Inspection Protocol Form; PHMSA Control Room Management Inspection Form. Each line bar in the graph is 6 hours of usage. Service Brakes b. Feel free to customize this checklist to fit your needs. This report is not required to be submitted to the Bureau but should be kept on-site for review upon request. closed tight psid closed tight psid psid #1 check psid air inlet psid psid rpba check valve #1 must hold minimum of 5 psid and relief port should open minimum 2 psid. (AFSA Form 110A) Page 2 of 6 REV. Check valve No 1 Check valve No 2 Please complete using BLOCK LETTERS ONE DEVICE PER FORM Job no Inspection and Maintenance Report of Backflow Prevention. Section 7-141, 2016 California Building Standards Code, requires the architect or engineer in responsible charge of a project to submit a Testing, Inspection and Observation (TIO) program to the Office of Statewide Health Planning and Development (Office) for approval prior to issuance of a building permit. "Record observations, test calibration, and repair results on form WGP 0132A, titled WilSOP Control Valve Inspection Report, or form WGP 0132C, titled WilSOP Relief Valve Inspection Report, as appropriate. 2) The drain from the relief valve must be able to drain by gravity. Your report will be uploaded within 24 hours of your inspection and you will be emailed a link to view the report. Inspection Type: Annual 5 Year. Piping Field Inspection Checklist Document No. This inspection should be run annually at least. 017: Seismic Gas Shutoff Valve Inspection Request Form: 164 KB View: IN/ Form. Float Gauge Dial Valve 2 Part# E Pressure Gauge: Mfg Date: PSI range Exp Date: * Isolating Valve: K Vaporizer Drain Valve: Part# Part# F Vapor Fill Valve: L Vaporizer Heating Element Part# KW/Volts/Phase G Customer Supply Valve: M Anhydrous Ammonia Decals Part# N Hazard Warning Decals O Acme Valve Caps H 85% Valve P Safety Relief Valve Caps. Inspect and indicate as: Satisfactory - S, Unsatisfactory - U, or Not Applicable - NA WALK AROUND INSPECTION S /U/ NA MACHINERY INSPECTION S/U/ NA a Foundations a. A report containing the inspection and analysis of the fire hydrants and isolation valves within the aqueduct system is delivered to the customer. ON EPA Report No. Verify that there has been a signed, approved electrical inspection report from Tacoma Power or Ensure drain line is at grade from valve vault to wetwell. We are doing our part to help save the environment and as such, all of our reports are in electronic format. com Inspection Report Sample for Machine. form cl-01 consultant commissioning of hvac systems contractor building : sheet : / of / systems / equipment included : description equipment mounting & setting control , interlock & power wiring alignment of motors & drives piping , connections & accessories lubrication of equipment system startup checklist i - pre - startup inspection remarks. Backflow Preventer Inspection and Field Test Report PWS ID Water System Name File # Facility Name ☐Non-Residential Residential Service Address City Zip Contact Person Phone Email Hazard Type (if known) ☐DCVA RPBA ☐PVBA AG Other Preventer Physical Location ☐ New ☐. Current as of February 2019. COMMENTS: Contractor or A/B Operator must initial and enter date of Annual Shear Valve Inspection. 0 2 of 2 ACCEPT N/A 2 Check clearances for pipe expansion at the anchor locations, shoes are properly positioned in relation to support and allow for expansion. 0 System in service on inspection E. Brake Tubing f. Final Acceptance Inspection/Testing Taking the inspection/testing request • What to ask the caller Has the fire alarm system passed a 100% pre-test Are all emergency control functions working Will all contractors be available and present Fire Safety Consultants, Inc. Moreover, the template, with its ready-made standardized format would be handy when your staff have no idea on the needed framework of a service report. Air Gap Inspection Pass ☐ Fail ☐ test report, to identify the company. INSPECTION AND TESTING FORM (NFPA Inspection and Testing 1 of 4) INSPECTION, TESTING, AND MAINTENANCE 72–99 1999 Edition Figure 7-5. If your buildings have fire sprinkler systems, you need a Fire Sprinkler Maintenance Program to help ensure its proper operation. Appendix A 1. At the same time, fixed equipment and inspection recommendations that, for some valid reason, cannot be inspected or completed by their due dates can sometimes be deferred by using a valid risk-based deferral process. NOTE: The codes prescribe minimum safety requirements for pressure systems and are not design handbooks. form cl-01 consultant commissioning of hvac systems contractor building : sheet : / of / systems / equipment included : description equipment mounting & setting control , interlock & power wiring alignment of motors & drives piping , connections & accessories lubrication of equipment system startup checklist i - pre - startup inspection remarks. If you are offering security services which include fire alarm devices, you can use this fire alarm system report form template to monitor, inspect, test and evaluate all the fire alarm system devices you have. ENSURE no fluid leaks out of casing valve. RIG MAINTENANCE REPORT #2 of 12 Rig#: Make/Model: Serial #: Drilling Crew: Service Technician: Inspection Date: Location: Component: OK Needs repair Centrifugal pump priming system. It focuses on the credit management procedures identified by the nine successful lenders in our case studies as the most effective means for controlling risk. date retestdistrict pass fail. NOTE: This form is not to be used for inspections of mobile/overhead cranes, powered industrial trucks, or aerial lifts. Quality Inspection-Reports There are various Icons available in Quality Inspection Module which is as Group 1 : Data updation Doing Inward QC (( Explained in a separate manual )) Doing Outward QC (( Explained in a separate manual )) Doing In-process QC (( Explained in a separate manual )) Group 2 : QC Reports ( explained here ) OK Report. ndividual valve standards OP subject to agreement between the manufacturer and the purchaser if rot specified in individual valve standards. Users of these forms should keep track of the font and field size when filling in data in order to meet regulatory or customer needs. Are all valves and operators inspected for potentially detrimental conditions, such as:. INSPECTION AND TESTING FORM (NFPA Inspection and Testing 1 of 4) ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity ÊÊÊÊCircuit Style. 4 HEALTH AND SAFETY One of the most significant health and safety risks during valve inspection, exercising and maintenance is vehicle traffic. Sample Reports. All components designated for inspection in the NAHI Standards of Practice are inspected, except as may be noted in the "Limitations of Inspection" sections within this report. The advanced tools of the editor will guide you through the editable PDF template. ON EPA Report No. FBP-OS-PRO-00025-F01, Rev. INSPECTION GUIDELINES Page 9 of 17 POOL PIPING – 021 (RESIDENTIAL) Plumbing 010 Building permit and approved set of plans. therequest. The dealer will provide their own pre-deliver inspection, but those tend to be less detailed and performed by someone other than you. (5) "Certificate of operation" means a certificate issued by the executive director to allow the operation of a boiler. PUMP MAINTENANCE SCHEDULE AND CHECKLISTS Providing a maintenance schedule defined specifically by run hours or yardage pumped serves only as a general guideline given the large amount of variables a unit might be subject to, such as weather and ambient temperature conditions, jobsite conditions, material differences of concrete mix design, the load. Take the time to look at them. Reporting & Analytics Detailed inspection reports to get insights and fix problems faster. Services are often evaluated in writing in the form of a Formal Report or even monthly reports, depending on how a service is assessed. Day/Month/Year of Shear Valve Inspection Contractor or A/B Operator Initials. DOT-regulated cylinders used for propane must be requalified periodically by visual inspection or by. Q: I listened in on your recent webinar when you introduced all of us to the changes with the new 2012 Life Safety Code. If your buildings have fire sprinkler systems, you need a Fire Sprinkler Maintenance Program to help ensure its proper operation. Environmental Protection Agency Inspection/Maintenance Staff 2565 Plymouth Road Ann Arbor, MI 48105 25 June 1982 8501 Mo-Pac Blvd. The Board shall provide a copy of the firesafety inspection report to the local county, municipality, or independent fire control district within 10 days of the inspection. Use a separate form for each valve. plant boiler number. If you gather the information of the system by using this form, you can also easily export it to your fire alarm inspection form on excel. CHAPTER 35 - FIRE SYSTEMS INSPECTION, TESTING, AND MAINTENANCE (ITM) 35 - 3 hinder egress and ensure they receive the required inspection reports. How to Format an Inspection Report. The right choice of valves for any application is therefore very important. pdf STATE OF CALIFORNIA DEPARTMENT OF CALIFORNIA HIGHWAY PATROL. First and Second Half – 2009 (including corrosion, odorization, and emergency valves). Internal Pipe Inspection - this requires the opening of a flushing connection at the end of one main and removal of one sprinkler head near the end of a branch line. 900(3) Financial Mechanisms for Storage. T/O Testing Program. The advanced tools of the editor will guide you through the editable PDF template. please complete the following: test and maintenance report form author: richland water. please complete the following: test and maintenance report form author: richland water. All PIV & WPIV valves should be physically tried Semi-annually. Check valves internally inspected and all parts operate properly, move freely and are in good condition? B. backflow prevention assembly test and maintenance report the following form must be completed for each assembly tested. Inspection • Does the valve actually work? • Lift lever test •At least it’s not stuck shut… •Test at 75% of set pressure for boiler or pressure vessel valves •Section IV valves can be checked without pressure •Section VIII: Test lever required for valves for steam, air, and hot water over 140 deg. ) Control of entry. INSPECTION RELEASE CERTIFICATES AND CERTIFIED DOCUMENTATION TO BE SUBMITTED SUPPORTING VENDOR INVOICE. ATD pays for an electronic report hosting service. of water supplies Wet or Dry Supply: City Water Connection Size Fed 2 ways Curb or P. Many inspectors have websites which include sample inspection reports for prospective clients to view. dc – double check valve assembly - dc. valves susceptible to pressure locking or thermal binding should be considered during the selection of the sample of power-operated gate valves for inspection review. (2) The reports must include the following information: (i) facility registration number,. Monthly Inspections. Chapter 1 offers an introduction to control valves including definitions for common control valve and instrumentation. ALL NO ANSWERS TO BE EXPLAINED IN SECTION VII. e certifications, test reports, etc). OS&Y Should report within 2 revolutions. Internal Pipe Inspection - this requires the opening of a flushing connection at the end of one main and removal of one sprinkler head near the end of a branch line. to Walkthrough Inspection Report & keep at facility. EQUIPMENT DAILY CHECKLIST AND SAFETY INSPECTION FORM. Backflow Prevention Device Test Report To be submitted by the Property Owner, or Agent of an Industrial, Commercial, Institutional, or Multi-Residential building. These openings are to be inspected for the “presence of foreign organic and inorganic material. M-1003, QA - 7. Test and Repair Pressure Safety Valves Technology/Practice Overview Description If a pressure surge in a compressor, pipeline, or pressure vessel exceeds the maximum operating pressure for the system, pressure safety valves (PSVs, or pressure relief valves, PRVs) will open and vent excess gas to the atmosphere. The site inspection focuses on the implementation of risk controls used by contractors following the work health and safety (WHS) management plan assessment. Air Compressor i. 9 December 2015 SLAC-I-730-0A21S-053-R004 6 of 8. 3 Year Overfill Prevention Equipment Inspection Report Form - Georgia (united States) Is Often Used In Georgia Department Of Natural Resources, Georgia Legal Forms, Georgia (united States) Legal Forms, United States State Legal Forms And United States. Pressure test record number:. Instrumentation Inspection Report If there is an instrument (sensors, controllers, actuators, or whatever) that suffered irregularities, then the first action is to investigate, then necessary actions to be taken as per the inspection report. 44 Water Distribution. Feel free to customize this checklist to fit your needs. Serious Incident Involving a Chain Wheel Operated Valve A member received multiple injuries while working with a chain wheel operated valve when the actuator/operator (weighing approxi-mately 30-pounds) on an overhead line broke away striking him on the head. REPORT TYPE N/A 3. The specimen tested was one GVO Linear Valve Operator [hereinafter referred to in this report as the UUT (unit under test)]. The original of the report is to be given to the owner/occupier and retained on site for a minimum of 7. For example, reduced pressure backflow devices should not leak water. Prior to the inspection of the irrigation system, the following items must be completed, and placed in a sealed (water-proof) bag, attached to the *controller at the time of inspection: (The installer/contractor or homeowner need not be present at the time of inspection). City of Fort Worth. The site inspection focuses on the implementation of risk controls used by contractors following the work health and safety (WHS) management plan assessment. I first called to make an enquiring on how the process works, the lady who answered the phone was nice and friendly and was happy to explain the details and price for inspection. Sprinkler Pre-Inspection Checklist 2007 NFPA 13 Updated: 06/2008 Q System valves and gauges shall be accessible for operation, inspection, tests, and maintenance (13:8. T70487-001 for traceability purposes only. Report of Inspection, Testing, and Maintenance of Fire Pump Pump ID: Sample Fire Pump Report generated by Fire Pump Tester Software ™ by Hydro Flow Products, Inc. If you are offering security services which include fire alarm devices, you can use this fire alarm system report form template to monitor, inspect, test and evaluate all the fire alarm system devices you have. F620-053-000 Pre-Inspection Checklist for High Pressure Boilers 04/2010 Page 1 of 5 Administration and General Requirements. The top the tank blew off becuase the relief valve could not displace the air fast enough for the volume of water that was being pumped in. –Form (FSSD FC01) Application –Form (FSSD FC02) Certificate of Maintenance –Form (FSSD FC03) Inspection report by the Fire Safety Manager (FSM) / Building Owner –Application fee •Introduction of Form FSSD FC 03 (Inspection report by the FSM/Owner) •Additional System to be tested and certified by Professional Engineer (PE) 4. Check valves internally inspected and all parts operate properly, move freely and are in good condition? B. GENERAL NOTES This form is to be used for the purposes of section 38 of the Standard Plumbing and. backflow prevention assembly test and maintenance report the following form must be completed for each assembly tested. The following are inspection forms that the Gas Safety Division uses to conduct inspections of regulated gas utilities. Internal examination is performed at the following minimum four points: system valve, riser, cross main, and branch line. 15 Are dike drain valves closed and in good working condition? Yes No N/A 16 Are containment egress pathways clear and any gates/doors operable? Yes No N/A Other Conditions 17 Is the system free of any other conditions needing to be addressed for continued safe operation or that may affect the site SPCC Plan? Yes No Inspector Information. 03/04/05 through Amdt. It is the goal of the inspection to put a homebuyer in a better position to make a buying decision. WORK UNIT NUMBER 7. A home buyer hires a home inspector to learn about the home, and the inspection report is the document that the buyer is left with, detailing the results of the inspection. Q: I listened in on your recent webinar when you introduced all of us to the changes with the new 2012 Life Safety Code. TASK NUMBER 5f. Valves, Valve Components, Trim Inspections (Sealed Control Valves, Master Pressure Reducing). Pipeline Safety "Standard" Inspection Form. Weekly Tests Valves, piping n Check pump suction, discharge and bypass valves to ensure they are open and piping is free of leaks. OVERHEAD CRANE PRE-OPERATIONAL CHECKLIST (RECORDS ARE NOT REQUIRED) (SAMPLE FORM) CRANE NO. ball float valve inspection 7dqn wrs ilwwlqjv duh ydsru wljkw dqg ohdn iuhh" 100 ft. PREMISE ISOLATION ONLY and tests must be conducted by a certified tester under Schedule. 44 Water Distribution. VEHICLE TYPE TRACTOR TRAILER TRUCK INSPECTION AGENCY/LOCATION (OPTIONAL) (OTHER) VEHICLE HISTORY RECORD REPORT NUMBER FLEET UNIT NUMBER DATE 1. The inspection contract is usually included on the website, and it should give you a good idea of what will be included in the. com Inspection Report Sample for Machine. Deluge Valves – Interior Inspection 12. By providingthis document, neither AIG Global Property nor any of its employees make any warranty, express or implied, concerning the use of. Example: V40420. 5 Periodic tests of Hydraulic Elevators - Report Form. We would like you to take the time to read it thoroughly and have a full appreciation for our analysis. Overspeed Valves 8. Many inspectors have websites which include sample inspection reports for prospective clients to view. These Guidelines contain general information to assist in the inspection of fire hose racks. The components to be tested are SFC valve Interlocks. Chapter 5 State Requirements for Educational Facilities Section 5 Page 56 November 2012 c. SAFETY TEST FORM. This article reviews the importance of the 5-year fire sprinkler system inspection, testing, and maintenance. The example of a commercial property inspection report in PDF shown on the page is an free examples of report from such an inspector. Best Practices Manual for Small Drinking Water Systems Date:June 2007 Prepared for Office of Drinking Water Prepared by Manitoba Water Stewardship (Formerly Cochrane Engineering Ltd. I try to focus on topics and issues, rather than stories and anecdotes but you'll still find a few of those. • Form P-3A (Engineering-contractor data report for a complete boiler unit) • Form P-4 (Manufacturers partial data report) • Form P-4A (Manufacturers data report for fabricated piping) • Form P-4B (Report of hydrostatic testing of field mechanical assembled piping) • Form P-5 (Summary data report process steam generators, waste heat type). number of boilers in building subject to inspection 2. VALVE REPORT. hot water water tube. The standpipe (washer drain line) was not tested for leaks as a washing machine would need to be present to discharge water into the drain. This article reviews the importance of the 5-year fire sprinkler system inspection, testing, and maintenance. Pipeline Safety “Standard” Inspection Form. TASK NUMBER 5f. Each line bar in the graph is 6 hours of usage. scope of dry-docking, inspection and repair to be carried out. This form does not relieve the owner of the responsibility of complying with the other requirements of NFPA 25-1998 for the Inspection, testing and maintenance of Fire Pumps. Main Operating Valve Water Drainage (pumped out if non-draining) Lower Stem Standpipe/Shoe Assembly. Hot Water Heater Safety Features & Water Heater Safety InspectionsWater heater safety inspection points, Authorities recommending water heater safety inspections, How to compare various safety features of hot water heating methods: electric, gas, high efficiency gas, oil, high efficiency oil, solar, tankless coils, etc. CHP 108 (Rev. 44 Water Distribution. (4) report as in need of repair a temperature and pressure relief valve that does not operate when the valve is of an operable type and operation will not cause damage to persons or property as reasonably determined by the inspector (for example, it would be reasonable not to operate the valve if there is improper or undetermined termination of. Inspection Type: Annual 5 Year. This article reviews the importance of the 5-year fire sprinkler system inspection, testing, and maintenance. Interior of dry pipe valves. Inspection Report completed as required? k. To the left of the graph is the number of cubic feet that are reported. I recommend your home inspection report system to all Inspectors and all in training inspectors. (20 or fewer sprinklers shall not require testing in. The FAI package shall include the FAI form, annotated drawing, and all supporting documentation (i. Instructions First Article Inspection (FAI) Report for form MDC 1016 1. You may have to take into consideration the environment and operating conditions for developing an inspection frequency. I first called to make an enquiring on how the process works, the lady who answered the phone was nice and friendly and was happy to explain the details and price for inspection. PUMP MAINTENANCE SCHEDULE AND CHECKLISTS Providing a maintenance schedule defined specifically by run hours or yardage pumped serves only as a general guideline given the large amount of variables a unit might be subject to, such as weather and ambient temperature conditions, jobsite conditions, material differences of concrete mix design, the load. The right choice of valves for any application is therefore very important. ALBEMARLE COUNTY SERVICE AUTHORITY. What does the 5-year fire sprinkler inspection include? When a five-year fire sprinkler inspection takes place, a fire protection inspector will verify the operation and condition of check valves and internally inspect pipe. PART NAME - Nomenclature of the article listed in block (2). You can add more item if you need more detail inspection on particular area. Form 9— Report on inspection and testing of backflow prevention devices, registered air gaps and registered break tank GENERAL NOTES This form is to be used for the purposes of section 38 of the Standard Plumbing and Drainage Regulation 2003. 4 BR / ADOS Prior to Start Work Review Each unit type Section 2 As per Specification Sample Submission • Engineered Wood • Underlay • Skirting • Wood Filler • Moisture Barrier • Adhesive. 0 Hangers and seismic bracing appear undamaged and tightly attached E. EPA 460/3-82-006 DCN 82-240-016-17-12 GUIDANCE ON QUALITY CONTROL FOR INSPECTION/MAINTENANCE PROGRAMS FINAL REPORT Prepared by: Radian Corporation Prepared for: U. 407 Requirements for test and inspection of specification cargo tanks. Test and Repair Pressure Safety Valves Technology/Practice Overview Description If a pressure surge in a compressor, pipeline, or pressure vessel exceeds the maximum operating pressure for the system, pressure safety valves (PSVs, or pressure relief valves, PRVs) will open and vent excess gas to the atmosphere. The washing machine water supply valves were operated and no deficiencies were present at the time of inspection unless otherwise noted in this report. Ensure that there are extra sprinkler heads on site, as well as the tools, to change out the sprinkler heads. OIL ADDED FILTER CHANGE. Well to get right to the point, I have been using Report Host from the start of my business, Report Host is the best and only inspection software I use and will ever use. -NFPA 25 13. The best checklist for your workplace is one that has been developed for your specific needs. Take the time to look at them. new existing replaced (old serial # replaced) assembly location facility address contact person phone. For your convenience in understanding the report the rating system is defined again below. form cl-01 consultant commissioning of hvac systems contractor building : sheet : / of / systems / equipment included : description equipment mounting & setting control , interlock & power wiring alignment of motors & drives piping , connections & accessories lubrication of equipment system startup checklist i - pre - startup inspection remarks. Valves; Parts For Electric Operated Test Pumps; Test Record Forms; EDDY CURRENT INSPECTION FORM. The example of a commercial property inspection report in PDF shown on the page is an free examples of report from such an inspector. (AFSA Form 110A) Page 2 of 6 REV. The Board shall provide a copy of the firesafety inspection report to the local county, municipality, or independent fire control district within 10 days of the inspection. The latest fillable PDF version of the VA 26-8731a was issued on January 1, 2001 and can be downloaded down below or found on the Veterans Affairs Forms website. Chapter 14 | Installation, Inspection, Maintenance, and Repair Requirements. Deluge Valves – Interior Inspection 12. 5 as amended by Washington State). VALVE INSPECTION REPORT Name of Complex: _____ Address: _____ Valve Number Location Date Inspected Inspected By Valve Number Location Date Inspected Inspected By Valve Number Location Date Inspected Inspected By. The items listed are those that cause the most damage and result in the more frequent and severe claims. We appreciate your confidence in us and we recognize the importance of this document. Appendix A 1. valve is shut down too quickly, the weak link in the system will go first. ADDENDUM 1 TO PROCEDURES FOR INSPECTION, MAINTENANCE, REPAIR, AND REMANUFACTURE OF DRILLING EQUIPMENT 3 C. Box 5581 Farmington, NM 87499 Facility Registration CT # 12456 Inspection Start Date: 10 / 2012 Test Report Number: VKTEST MC-306/DOT-406 Annual External Visual Inspection and Leakage Test Report. Composing an inspection report requires careful attention on the process and timeline of the inspection process to make the report easy to understand. Site inspection report. These openings are to be inspected for the “presence of foreign organic and inorganic material. The inspection report is not a repair list for the seller. This form, filled out and signed, can provide such documentation. If any item or comment is unclear, you should ask the inspector to clarify the findings. Box 5581 Farmington, NM 87499 Facility Registration CT # 12456 Inspection Start Date: 10 / 2012 Test Report Number: VKTEST MC-306/DOT-406 Annual External Visual Inspection and Leakage Test Report. OQ Plan and Records Inspection; Operator Qualification Field Inspection Protocol Form; PHMSA Control Room Management Inspection Form. Is a shutoff valve installed at the fuel connection and is the valve arranged so that operation of the valve can be accomplished from outside the compartment in which the tank is located and from outside the engine compartment and outside the house bulkheads at or above the weather deck of the vessel? (19. The components to be tested are SFC valve Interlocks. We are an industrial valve company, so most of our inspections are based upon drawings and 90% of items to be inspected are dimensions on the parts being received. check valve #1 chicago water department backflow preventer test report plumbing inspection department faxphone permit # original test time am. This form does not relieve the owner of the responsibility of complying with the other requirements of NFPA 25-1998 for the Inspection, testing and maintenance of Fire Pumps. Pipe Inspection - Hydro Test, NDT, Visual and Dimension. package type scotch. this scope is provided for informational purposes only and is not to be used to develop cost proposals or to be included in reports. Not all improvements will be identified during this inspection. Some of the recurring problems we continue to experience from inspection deficiencies include: • Undetected closure of sprinkler system control valves • Inoperative fire pumps. The National Board's goal is to maintain the integrity of the National Board marks and symbols (NB, VR, and T/O) and the ASME Certification mark with V,UV, UD, HV, and NV designators. the actual, bridge specific, hydraulic inspection scope-of-work will be provided through the njdot project manager. Re: Incoming Inspection Form Attached is the form we use. 0 Effective Date: December 10, 2009 Page 2 of 12 NOTE: Before each use, check MSC Docs Online to ensure this copy is current. Serious Incident Involving a Chain Wheel Operated Valve A member received multiple injuries while working with a chain wheel operated valve when the actuator/operator (weighing approxi-mately 30-pounds) on an overhead line broke away striking him on the head. Visually assess the general condition of the tank or container and its appurtenances such as flange joints, expansion joints, valve glands and bodies, catch pans, pipeline supports, locking of valves, and metal surfaces. Backflow Preventer Inspection and Field Test Report PWS ID Water System Name File # Facility Name ☐Non-Residential Residential Service Address City Zip Contact Person Phone Email Hazard Type (if known) ☐DCVA RPBA ☐PVBA AG Other Preventer Physical Location ☐ New ☐. During your contractual inspection period, you should carefully evaluate any property component or system that did not receive a "Functioning as Intended" rating in the report, any suggestions or comments made in the report, and any items or areas. ALBEMARLE COUNTY SERVICE AUTHORITY. QUARTERLY INSPECTION CHECKLIST. A worker may be assigned in making an inspection of all the equipment in the company or a person may be given the duty of checking the necessary things before going. INSPECTION FORM (see APPENDIX E) from the customer. –Form (FSSD FC01) Application –Form (FSSD FC02) Certificate of Maintenance –Form (FSSD FC03) Inspection report by the Fire Safety Manager (FSM) / Building Owner –Application fee •Introduction of Form FSSD FC 03 (Inspection report by the FSM/Owner) •Additional System to be tested and certified by Professional Engineer (PE) 4. For the year _____ Initial test - Complete entire form Annual test - Complete Part A only Public Water Supply Account No. Office Safety Inspection Checklist • The scope of this safety inspection form is designed to assist office personnel in identifying unsafe conditions. Take the time to look at them. e certifications, test reports, etc). 4 HEALTH AND SAFETY One of the most significant health and safety risks during valve inspection, exercising and maintenance is vehicle traffic. To help protect the safety of the City’s drinking water, it is mandatory under the City of Toronto’s Water Supply By-law for property owners of industrial, commercial, institutional and Part 3 residential properties (as defined by the Ontario Building Code), as well as construction sites, to install a backflow prevention device on the water supply line(s) to their facility. VA Form 26-8731a is a United States Department of Veterans Affairs form also known as the "Water-plumbing Systems Inspection Report (manufactured Home)". CHECK VALVE INTERNAL INSPECTION. Reports with Home Inspector Pro are designed to be easy to read and to the point. Were building management and occupants notified of the inspection? b. The filling of the tank was made with water from a fire hydrant. Essentials of Leak Detection and Repair – Provides a discussion of the importance of leak detection and repair, the major causes of leaks, and how to identify leaks. Are all valves and operators inspected for potentially detrimental conditions, such as:. 2018-11-22. Form MD-115, Defective Wheels Removed, Causing Derailments, or Line-of-Road Setouts Report completed as required? l. However, for annual, semi‑annual, or quarterly inspection requirements, Ryan Fireprotection provides experienced and trained staff who know exactly what to look for when performing the inspections: Daily / Weekly Visual Inspections. Valve Shell Test or Body test is performed after successful completion of valve individual components e. First and Second Half - 2009 (including corrosion, odorization, and emergency valves). Check cut-off valves to be airtight. SAFETY TEST FORM. Description for Series/Mile Post/Valve Section: Refer to O&M Section 1400 for Records Retention and Form Distribution. The specimen tested was one GVO Linear Valve Operator [hereinafter referred to in this report as the UUT (unit under test)]. Note that not all activities listed below will be applicable on every project; therefore, inspection review is only necessary for the applicable requirements listed below. This article reviews the importance of the 5-year fire sprinkler system inspection, testing, and maintenance. Inspection tags can be used to inform employees when inspection was last conducted on a part or piece of equipment, offering confidence that the equipment is. Does the owner/operator have a SPR, and has it been reviewed/revised within the Is a check valve in place for fill pipes where. LUBRICATION AND INSPECTION REPORT. M-1003, QA - 7. It is already filled with general fire safety item that must be checked during the inspection. Below the graph is the day, date, and time of the usage. Pipeline Safety "Standard" Inspection Form. INSPECTION FORM (see APPENDIX E) from the customer. Intro to Fire Inspection Checklist: Fire Inspection Checklist - Process Street In this Process Street Fire Inspection Checklist, we cover how to run a fire safety inspection on a residential or commercial building. For your convenience in understanding the report the rating system is defined again below. 1 For drop tube shutoff valves in d iesel tanks, excessive corrosi on not present APPENDIX A-3: SAMPLE FORM FOR ANNUAL UNDERGROUND STORAGE SYSTEM INSPECTION CHECKLIST – P 8. The receipt inspection revealed that the UUT arrived at Wyle Laboratories with no serial number identification. Form 9—Report on inspection and testing of backflow prevention devices, registered air gaps and registered break tanks. • The bullseye will identify the fire plug number and the valve number(s) necessary to isolate the fire plug in the event of damage. 2 Gauges on dry, preaction, and deluge systems shall be inspected weekly to ensure that normal air and water pressures are being maintained. PUMP MAINTENANCE SCHEDULE AND CHECKLISTS Providing a maintenance schedule defined specifically by run hours or yardage pumped serves only as a general guideline given the large amount of variables a unit might be subject to, such as weather and ambient temperature conditions, jobsite conditions, material differences of concrete mix design, the load. The following procedures shall be performed at each required quarterly inspection of a fire sprinkler system. please complete the following: test and maintenance report form author: richland water. form cl-01 consultant commissioning of hvac systems contractor building : sheet : / of / systems / equipment included : description equipment mounting & setting control , interlock & power wiring alignment of motors & drives piping , connections & accessories lubrication of equipment system startup checklist i - pre - startup inspection remarks. Disclaimer: The specific needs, practices, form of government and other operational procedures of your governmental entity may impact whether this example is appropriate for your use. If any item or comment is unclear, you should ask the inspector to clarify the findings. Some customers also provide service reports as a token of gratitude and appreciation for services worth commending. The Data Report Forms posted on the ASME website are provided to the user as a convenience to aid meeting the ASME Boiler and Pressure Vessel Code requirements. VALVE NUMBER Insert the valve number. ADDENDUM 1 TO PROCEDURES FOR INSPECTION, MAINTENANCE, REPAIR, AND REMANUFACTURE OF DRILLING EQUIPMENT 3 C. Gas Services, LLC P. The washing machine water supply valves were operated and no deficiencies were present at the time of inspection unless otherwise noted in this report. for Inspection and Evaluation SUBJECT: Inspection of Best Practices of Section 7(a) Lenders We are pleased to submit our inspection report on the Best Practices of Section 7(a) Lenders. Brake Inspector Qualification Form. responsibility of reviewing the changes to Alberta’s Commercial Vehicle Inspection Manual (Version 2. Sample Reports. Does the owner/operator have a SPR, and has it been reviewed/revised within the Is a check valve in place for fill pipes where. It is the goal of the inspection to put a homebuyer in a better position to make a buying decision. The State Fire Marshals Office is not to be considered a source of training in the dispensing of propane. The weak links are almost always at the flanges, or pipe joints. A worker may be assigned in making an inspection of all the equipment in the company or a person may be given the duty of checking the necessary things before going. The form can be completed in one of two ways: 1. Below the graph is the day, date, and time of the usage. Valves, Valve Components, Trim Inspections (Sealed Control Valves, Master Pressure Reducing). new existing replaced (old serial # replaced) assembly location facility address contact person phone. FIRE HOSE RACK INSPECTION GUIDELINES Always follow manufacturer’s instructions and recommendations for inspection of equipment. Check valve No 1 Check valve No 2 Please complete using BLOCK LETTERS ONE DEVICE PER FORM Job no Inspection and Maintenance Report of Backflow Prevention. –Form (FSSD FC01) Application –Form (FSSD FC02) Certificate of Maintenance –Form (FSSD FC03) Inspection report by the Fire Safety Manager (FSM) / Building Owner –Application fee •Introduction of Form FSSD FC 03 (Inspection report by the FSM/Owner) •Additional System to be tested and certified by Professional Engineer (PE) 4. CAPACITY TYPE LOCATION SHIFT 1 2 3 OPERATORS NAME: INSTRUCTIONS: Check all items. Valves – the sprinkler valves should be internally inspected every five years. The right choice of valves for any application is therefore very important. The specimen tested was one GVO Linear Valve Operator [hereinafter referred to in this report as the UUT (unit under test)]. Valve Inspection 1. For USTs greater than 110 gallon capacity. com Inspection Report Sample for Machine.