ASB-SF-006 RPE Daily Inspection Record.v3

• Name of User:

• Mask ID No:

• Date:

  Date
• Site/Location:
  Address

• Job Number:

• Mask Pic:

  Media

• Storage Box Pic:

  Media

Sundstrom Half Mask SR100

• Cleanliness of Kit:

  Good

  Fair

  Poor

• Harness:

  Good

  Fair

  Poor

• Clasp:

  Good

  Fair

  Poor

• Harness Plastic:

  Good

  Fair

  Poor

• Mask Outer:

  Good

  Fair

  Poor

• Harness lug Locations:

  Good

  Fair

  Poor

• Exhalation Valve:

  Good

  Fair

  Poor

• Exhalation Valve Holder:

  Good

  Fair

  Poor

• Filter Retainer Plastic:

  Good

  Fair

  Poor

• Inhalation Valve:

  Good

  Fair

  Poor

• Filter Condition:

  Good

  Fair

  Poor

• Filter Cartridge Expiry Date:

• Storage Box:

  Good

  Fair

  Poor

Scott Phantom Vision Powered Respirator

• Cleanliness of Kit:

  Yes

  No

  N/A

• Storage Box:

  Yes

  No

  N/A

• Battery Casing:

  Yes

  No

  N/A

• Battery Contacts:

  Yes

  No

  N/A

• Belt Clip:

  Yes

  No

  N/A

• Belt:

  Yes

  No

  N/A

• Harness:

  Yes

  No

  N/A

• Harness Buckles:

  Yes

  No

  N/A

• Harness Lugs:

  Yes

  No

  N/A

• Mask Outer:

  Yes

  No

  N/A

• Mask Harness Buttons:

  Yes

  No

  N/A

• Mask Harness Lugs:

  Yes

  No

  N/A

• Visor:

  Yes

  No

  N/A

• Exhalation Valve Cover:

  Yes

  No

  N/A

• Exhalation Valve:

  Yes

  No

  N/A

• Exhalation Valve Holder:

  Yes

  No

  N/A

• Blower Operation:

  Yes

  No

  N/A

• Blower Lead & Connectors:

  Yes

  No

  N/A

• Blower Cannister Seal: (N/A ON PHANTOM VISION)

  Yes

  No

  N/A

• Blower ‘o’ Ring: (N/A ON PHANTOM VISION)

  Yes

  No

  N/A

• Blower grille (N/A ON PHANTOM VISION)

  Yes

  No

  N/A

Scott Vision 3 RAS Airline Kit

• Face Piece:

  Yes

  No

  N/A

• Visor:

  Yes

  No

  N/A

• Head Harness:

  Yes

  No

  N/A

• Buckles:

  Yes

  No

  N/A

• Exhalation Valve:

  Yes

  No

  N/A

• Orange Filter Cover c/w Cord:

  Yes

  No

  N/A

• Demand Valve & Hose Assembly:

  Yes

  No

  N/A

• Bandolier and Waistbelt:

  Yes

  No

  N/A

• Demand Valve Locking Catch:

  Yes

  No

  N/A

• Non Return Valve Dust Cap:

  Yes

  No

  N/A

• Outlet ‘o’ Ring:

  Yes

  No

  N/A

• In-Line Coalescing Filter:

  Yes

  No

  N/A

• Bypass Valve Knob:

  Yes

  No

  N/A

• Functional Check of Kit:

  Yes

  No

  N/A

• Cleanliness of Kit:

  Yes

  No

  N/A

• Name:

  Sign