Title Page

Cylinder Inspection

  • Check the cylinder for damage. Is the cylinder in acceptable shape?

  • Select Cylinder.

  • Is current Hydro Test date valid?

  • Select Cylinder.

  • Does cylinder valve function properly?

  • Select Cylinder.

Inspection of backpack and harness.

  • Inspect all straps for damage. Are they in acceptable condition?

  • 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.

  • Add media

  • Inspect the back pack for any damage or missing parts. Is the pack in acceptable condition?

  • 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.

  • Add media

  • Inspect all hoses for damage/wear. Are the hoses in good shape?

  • 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.

  • Add media

Functional checks.

  • Functionally check all of the straps and buckles. Are these moving freely?

  • 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.

  • Add media

  • Functional check of the face mask. Are all the straps working and is the mask in good condition? Is the nose cup seated properly?

  • 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.

  • Add media

  • Functional check of the regulator with the face mask? Doe they connect/disconnect easily? Is the regulator cover in good condition?

  • 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.

  • Add media

  • Functional check of the Emergency Bypass valve. Is this working correctly and freely?

  • 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.

  • Add media

  • Functional check of the Low Pressure Alarm. Is this working correctly?

  • 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.

  • Add media

  • 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.

  • 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.

  • Add media

Deficiencies. Note any other deficiencies below along with the SCBA number associated with it.

  • Any additional deficiencies or notes?

Sign below.

  • Inspection completed by:

Deficiency Repairs: This portion is to be filled out by the Fire Chief or their designate.

  • Have all the deficiencies been repaired for all items noted above?

  • Completed on?

  • Additional notes or follow up items list below.

  • Completed by:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.