Chaparral Energy SCBA Inspection

• Field Office

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• SCBA/Owner

SCBA Inspection

• Is the SCBA free of damage?

  Yes

  No

  N/A

• What is the hydrostatic test date on the cylinder?

  Yes

  No

  N/A

• Is the cylinder free of damage?

  Yes

  No

  N/A

• Are shoulder straps and waist belt free of damage?

  Yes

  No

  N/A

• Are all the buckles and fasteners free of damage?

  Yes

  No

  N/A

• Is the back plate free of damage? (Cracks or rust)

  Yes

  No

  N/A

• Do all of the connection points between the cylinder and the SCBA harness operate properly? Are they free of corrosion/damage?

  Yes

  No

  N/A

• Check all hoses and connection points for wear, cuts and damage.

  Safe

  At Risk

  N/A

• Activate the cylinder valve and compare pressure gauge readings.

  Safe

  At Risk

  N/A

• Attach the face piece and check regulator for proper operation.

  Safe

  At Risk

  N/A