Title Page
Cylinder Inspection
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Check the cylinder for damage. Is the cylinder in acceptable shape?
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Select Cylinder.
- Cylinder 1
- Cylinder 2
- Cylinder 3
- Cylinder 4
- Cylinder 5
- Cylinder 6
- Cylinder 7
- Cylinder 8
- Cylinder 9
- Cylinder 10
- Cylinder 11
- Cylinder 12
- Cylinder 13
- Cylinder 14
- Cylinder 15
- Cylinder 16
- Cylinder 17
- Cylinder 18
- Cylinder 19
- Cylinder 20
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Is current Hydro Test date valid?
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Select Cylinder.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Does cylinder valve function properly?
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Select Cylinder.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
Inspection of backpack and harness.
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Inspect all straps for damage. Are they in acceptable condition?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Inspect the back pack for any damage or missing parts. Is the pack in acceptable condition?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Inspect all hoses for damage/wear. Are the hoses in good shape?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Functional checks.
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Functionally check all of the straps and buckles. Are these moving freely?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Functional check of the face mask. Are all the straps working and is the mask in good condition? Is the nose cup seated properly?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Functional check of the regulator with the face mask? Doe they connect/disconnect easily? Is the regulator cover in good condition?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Functional check of the Emergency Bypass valve. Is this working correctly and freely?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Functional check of the Low Pressure Alarm. Is this working correctly?
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Activate the PASS device. Is this working correctly? Let the PASS device activate on its own to ensure that it is functioning correctly with the escalated alarms.
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Select the SCBA number. Make notes as to what the deficiency/issue is below and record in notes exactly which SCBA if there is more than one with an issue. Capture image if possible as well for each.
- SCBA 1
- SCBA 2
- SCBA 3
- SCBA 4
- SCBA 5
- SCBA 6
- SCBA 7
- SCBA 8
- SCBA 9
- SCBA 10
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Deficiencies. Note any other deficiencies below along with the SCBA number associated with it.
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Any additional deficiencies or notes?
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Sign below.
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Inspection completed by:
Deficiency Repairs: This portion is to be filled out by the Fire Chief or their designate.
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Have all the deficiencies been repaired for all items noted above?
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Completed on?
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Additional notes or follow up items list below.
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Completed by:
