Title Page
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Type Of Equipment
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Manufacturer
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Serial Number
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Model Number
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Equipment Type
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Maximum Pressure Rating
To be Completed by Inspector, Supervisor or Foreman of Those Performing the Work
Equipment Safety Checks
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Hoses checked for condition, secured, properly arranged, and rated for a minimum 3 times the highest working pressure.
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High-pressure hose connections tightened and inspected for cracks, leaks or chips in the housing?
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High pressure hose has been check for leaks, punctures and breaks?
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Relief device rating checked against the lowest rated components?
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Equipment guards in place (trigger guards, rotational guards)?
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Shut off controls are operating properly?
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Trigger assembly and pressure gun are in working condition with no breaks, cracks or bad couplings?
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Pressure wand/gun if free of cracks and in working condition
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Rotating nozzles have been inspected and are in working condition?
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Fuel tank is in working condition with no cracks, breaks or leaks?
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Overall Condition of equipment
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Recommendation
- Equipment is acceptable and approved for continued service at time of inspection
- equipment is not acceptable and shall be removed from service immediately
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Inspector's Signature Colin Alexis - Certified Inspector