Title Page
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Conducted on
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Prepared by
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ITP Ref No:
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Level:
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Area:
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Zone / Room:
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Drawing No:
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Revision No:
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Calibration Report No:
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Date Calibrated:
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Calibration Expiry
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Service Type:
- Cold Water
- Hot Water
- Non Potable
- Warm Water
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Direction of Flow Correct
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Material Type:
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Identification Labels Correct
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(For HDPE / Poly refer to AS2566 Appendix M for test procedure)
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Pipework visually inspected for damage and there are no open ends
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Pressure limiting valves, hot water heaters, TMV's and equipment disconnected or isolated prior to test
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Pipeline filled with water and water flushed
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Pipeline filled with water and air blend from system
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Testing in accordance with AS3500.1 Clause 18:37
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Test Commenced at:
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Pressure reading at commencement:
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Test Completed at:
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Pressure reading at completion:
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Test
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Minimum test time is 30 minutes @ 1500 KPA or 1.5 times working pressure
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Test witnessed on behalf of Client Representative:
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Name:
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Signature
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Date & Time:
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Test carried out by:
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Signature
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Walls can be closed:
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Ceilings can be closed:
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Trenches can be backfilled:
