Fire System Preventative Maintenance Inspection

• Job No.

• Client / Site

• Asset No.

• Work Order #:

• Purchase Order #:

• Machine Make and Model

• Conducted on

  Date

• Conducted by

• Photo of Equipment:

  Media

• Last Service Date:

  Date

• Last Service Level (if unknown: 0):

Diagnostics

• Download ICM history. Attach image of history log and assess

  Media

• Have there been reoccurring faults?

  No

  Yes

• Action taken to rectify

Cylinder(s) and Cartridge(s)

• Type:

• Size:

• PT Date:

  Date

• Serial Number:

• Condition:

  Good

  Fair

  Poor

  N/A

• Cylinder(s) are in date:

  Yes

  No

  N/A

• Cylinder(s) secure and stickers legible:

  Yes

  No

  N/A

• Picture of cylinder(s):

  Media

• Fire extinguisher(s)

  Yes

  No

  N/A

Extinguishers:

• Extinguishers in date and serviced

  Yes

  No

  N/A

• Extinguisher Condition:

  Good

  Fair

  Poor

  N/A

• Extinguisher Bracket Condition (if applicable):

  Good

  Fair

  Poor

  N/A

Actuators

• Quantity of Actuators:

• Actuator(s) in good condition:

  Good

  Fair

  Poor

  N/A

• All gauges in the green and legible:

  Yes

  No

  N/A

• Tamper tags and AS5062 tags in place and legible:

  Yes

  No

  N/A

Detection and Wiring

• Detection Type:

  Select LOP Tube Firewire Heat Sensor

  • LOP Tube
  • Firewire
  • Heat Sensor

• Detection Condition:

  Good

  Fair

  Poor

  N/A

• Cabling and detection wiring is in good condition and segregated as required

  Yes

  No

  N/A

• Pictures of wiring condition and segregation

  Media

Hosing

• Hose condition, support and segregation:

  Good

  Fair

  Poor

  N/A

• Pictures of hosing condition and segregation

  Media

• Nozzles caps on and nozzles pointing in correct position:

  Yes

  No

  N/A

• Warning and info labels are installed as required and in good condition:

  Yes

  No

  N/A

• Summary of over all condition of fire suppression system:

• All defects needing rectification that cannot be completed at time of inspection should be noted in the following question.

• Has corrective action been taken on all defects/improvements noted in this report that could be rectified at time of inspection?

  Yes

  No

  N/A

• Supervisor notified:

• Is further corrective action required?:

  Select No Yes - Corrective Action Required

  • No
  • Yes - Corrective Action Required

• Details of Corrective Action required:

• Site supervisor notified:

  Sign

• Relevant photos of defects:

  Media

• Most urgent defect(s) to be rectified:

  Select Next Service As soon as possible Immediately / Before returning to service

  • Next Service
  • As soon as possible
  • Immediately / Before returning to service

• Equipment to be tagged out of service.

• Out of service tag placed on suppression system

  Yes

  No

  N/A

• Recommendations:

• Sign off on inspection

  Sign