Information

  • Client / Site

  • Report No.

  • Date of Inspection

  • Address of Establishment
  • Contact Person and Phone Number

  • Prepared by

Valve Information and Testing Results

  • Make of Mixing Valve

  • Model

  • Valve Size

  • Valve Location/Building

  • Valve Identification Number

  • Photo of Valve

  • Total number of outlets served by this valve

  • Baths

  • Basins

  • Showers

  • Other outlets

  • Details of other outlets

  • Temperature of mixing valve outlets in °C

  • Fail Safe Test

  • Valve considered satisfactory for further use?

  • Temperature as on plan or in spec. In °C

  • Temperature as in HOSPLAN (referred to as the Code of Practice) page 54; section 7:
    For Adults - 40.5 to 43.5°C
    For Children - 38 to 40.5°C
    For Neonatals (babies) - 35 to 38°C

  • Dynamic hot water pressure in kPa

  • Dynamic cold water pressure in kPa

  • CV Trade Services
    59-61 Qantas Drive
    Eagle Farm Qld 4009

  • Name of accredited tester

  • Accreditation Number

  • Temperature checked and Fail/Safe witnessed by

  • Employed by

  • Position held

  • Testers Signature

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.