SF-063 RPE checklist

• Conducted on

  Date

• Conducted by.

  Select

• please detail other

• inspection type

  Select Daily/ Pre use Thorough examination (max 3 Monthly)

  • Daily/ Pre use
  • Thorough examination (max 3 Monthly)

• 

Details of inspection

• Type of Mask

  Half Face.

  Full Face.

  Powered Air Full Face.

  Other

• please detail an overview of the inspection and any issues found

• Is this a daily or monthly inspection

  Select Daily/ Pre use Thorough examination (max 3 Monthly)

  • Daily/ Pre use
  • Thorough examination (max 3 Monthly)

Details of inspection Half Face

• Model number and type

• 

• Any Faults

  Yes

  No

• Resolution (if the fault cannot be resolved the maks must be removed from service and a new mask issued)

• Insert an image if relevant

  Media

Details of inspection Half Face

• Model number and type

• 

• The maks has been stripped back , taken apart and inspected for the below

• Cleanliness

• Face piece / seal

• Visor (if applicable )

• Head straps/ buckles

• Valves / seals

• Insert an image if relevant

  Media

Detailed inspection

• The mask has been taken apart cleaned and inspected in detail

  Yes

  No

  N/A

• please carry out a detail inspection of the mask

• Any Faults

  Yes

  No

• Resolution (if the fault cannot be resolved the maks must be removed from service and a new mask issued)

• Is this a daily or monthly inspection

  Select Daily/ Pre use Thorough examination (max 3 Monthly)

  • Daily/ Pre use
  • Thorough examination (max 3 Monthly)

Details of inspection Full Face

• Model number and type

• The maks has been stripped back , taken apart and inspected for the below

• Cleanliness

• Face piece / seal

• Visor (if applicable )

• Head straps/ buckles

• Valves / seals

• Motor

• Batteries Charged

• Airflow Test

• Insert an image if relevant

• Any Faults

  Yes

  No

• Resolution (if the fault cannot be resolved the maks must be removed from service and a new mask issued)

• Model number and type

• Harness Cuts

• Harness Worn, Overextended

• Harness Mounting Position

• Clips, bent, twisted

• Roller Damage

• Clips Correct Handling

• Harness Flaps

• Harness Flaps Clean

• Visor Scratched

• Visor Cracked

• Visor Position

• Visor Clamp Position

• Visor Clamp & Screw Nuts

• Valve Cover Clean (Phantom)

• Diaphragm Condition (Phanton)

• Air Delivery Tube (Gemini)

• Motor Mount (Phantom)

• Motor Cracks or Damage (Phantom)

• Motor Inner Seal (Phantom)

• Motor Outer Seal (Phantom)

• Battery Connection & Lead (Phantom)

• Battery Housing

• Power Pack Condition

• Switch Power Pack (Gemini)

• Face Piece Pin Holes & Splits

• Face Piece Cleanliness

• Face Piece Cleanliness

• Under Visor Clamp

• Belt &Clip Condition

• Is this a daily or monthly inspection

  Select Daily/ Pre use Thorough examination (max 3 Monthly)

  • Daily/ Pre use
  • Thorough examination (max 3 Monthly)

Details of inspection Air fed

• Model number and type

• The maks has been stripped back , taken apart and inspected for the below

• Cleanliness

• Face piece / seal

• Visor (if applicable )

• Head straps/ buckles

• Valves / seals

• Motor

• Batteries Charged

• Airflow Test

• Insert an image if relevant

• Any Faults

  Yes

  No

• Resolution (if the fault cannot be resolved the maks must be removed from service and a new mask issued)

• Model number and type

• Clips, bent, twisted

• Clips Correct Handling

• Harness Flaps

• Harness Flaps Clean

• Visor Scratched

• Visor Cracked

• Visor Position

• Visor Clamp Position

• Visor Clamp & Screw Nuts

• Valve Cover Clean

• Diaphragm Condition

• Air Delivery Tube

• Motor Mount (Phantom)

• Motor Cracks or Damage

• Motor Inner Seal

• Motor Outer Seal (Phantom)

• Battery Connection

• Battery Housing

• Power Pack Condition

• Switch Power Pack

• Face Piece Pin Holes & Splits

• Face Piece Cleanliness

• Face Piece Cleanliness

• Under Visor Clamp

Filter Type

• 

• Filter type.

  Select P A+ A B E K C04 HG NO R

  • P
  • A+
  • A
  • B
  • E
  • K
  • C04
  • HG
  • NO
  • R

• ABECK Protection level (for multiple or mixed protection levels make a comment in the comments section e.g. gas filter class 2 - partial filter class 3 )

  1

  2

  3

• Filter Expiry Date.

  Date

• Particle Protection factor

  20 (P3)

  40

  60 (clean space )

  Other

• Details of ''other'' protection level

• Is this the correct filter type for the task

  Yes

  No

  N/A

• Continue with the inspection but, do NOT start work until your supervisor issues you with the correct filter type

Close out

• I sign below to state I have carried out an inspection on my RPE and find it to be:

  Fit for use

  NOT fit for use

• what action have you taken

• Name of owner

  Select

• Add signature

  Sign