Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Serial Numbers of hoses checked
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Enter hose details here:
Hose Marking
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Is the hose label present and in good condition?
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Is the hose unique I.D number clearly visible?
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Is the hose pressure rating clearly visible?
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Is the inspection date clear and visible?
Hose Type and Application
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What type of hose is being used?
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Chemical Medium
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Minimum Temp
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Maximum Temp
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Maximum Service Pressure (PSI)
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External Conditions (Temp Spikes, Environ. Factors, Contam. Area)
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Hose condition
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Is there any visible damage of hose outer cover, scoring, exposed wire, crush, kink?
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Is there any visible abrasion, deformation or cut to hose exterior?
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Is there any hose outer cover bulge?
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Is there hose outer cover delamination?
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Are end-fitting seal surfaces damaged?
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Are end-fitting threads damaged?
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Are end-fittings corroded?
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Are accessories damaged / detached?
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Does the hose have whip checks fitted, and are they in good condition?
