Attachment D - Fire Pump Test Form.pdf

Company Name (City), WA 98000 Telephone #

SYSTEM #

FIRE PUMP SYSTEM

INSPECTION AND TESTING REPORT

Date Building Name

Time Address

Inspector City, State, Zip

Contact Phone

Monitoring Entity

Company Phone Account

Authority Having Jurisdiction

Name Phone

Service: Quarterly Semi-Annually Annually Fire Pump type; electric diesel controller voltage without load with 100% load

Yes No N/A 2 YEAR, Control Valves, operate and lubricate valve to endure operability.

2 YEAR, Controllers, calibrate pressure switches.

2 YEAR, Controllers, exercise circuit breakers and switches to verify operability.

2 YEAR, Controllers, inspect fuses.

2 YEAR, Pumps, check coupling alignment to ensure that the shaft is aligned.

2 YEAR, Pumps, check pump shaft end play.

2 YEAR, Pump, lubricate bearings.

2 YEAR, Pump, lubricate couplings.

2 YEAR, Pump, lubricate right angle drives.

2 YEAR, Fuel, sample fuel to verify quality.

2 YEAR, Relief Valves, calibrate valves.

2 YEAR, Emergency Power Supply, test to verify availability and capability for pump motor.

5 YEAR, Pump, conduct flow test to verify pump output System riser location Size Make Model

Quick opening device N/A Make Model Date of last full trip Trip Test Water PSI Air PSI Trip Air PSI Trip Time sec Water delivery min sec Waterflow test results Main Drain Size Static Residual Restore Problems Found:

Corrections Made:

Comments:

This Testing Was Performed In Accordance With Applicable Standards

Inspector Certificate Date Time

Inspector Signature

Site Representative Date Time

Signature

Fire Pump Information on page 2.

Fire Pump Information

Fire Pump #1 Information Manufacturer Type Serial # Comments:

RPM Max Press Impeller diameter GPM

Fire Pump #2 Information: Hanger 0000 Manufacturer Type Serial # Comments:

RPM Max Press Impeller diameter GPM