Breathing Apparatus Sets - Check for "in progress" inspections first - Wodgina

• Conducted on

  Date

• Conducted by

  Select

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign

• Is the set available to inspect?

  Yes

  No

Mask

• Mask and straps in good condition

  Yes

  No

• Ensure mask straps are fully extended

  Yes

  No

Cylinder

• Cylinder Number

  Select

• Cylinder Pressure

• Condition

  Good

  Fair

  Poor

  N/A

• Scratches Into Carbon Fibre

  Yes

  No

Back Plate & Harness

• Back plate and harness in good condition

  Yes

  No

• PDU functional test

  Yes

  No

• Low pressure alarm (between 50 and 60 bar)

  Yes

  No

• High pressure leak test

  Yes

  No

• Completed by (Last Name and Initial)

• Completed by (Signature)

  Sign