Appendix_I,_DA_Form_3943_-_Annual_Dry_Pipe_Valve_Inspection_and_Tripping....pdf

(USE REVERSE SIDE FOR REMARKS EXPLAINING FAULTY CONDITIONS)

MAIN DRAIN TEST MADE

YES NO

PROTECTION RESTORED AFTER TEST (If not, why?)

YES NO

TEST SATISFACTORY (If not, why?)

YES NO

VALVE RECEIVING GOOD CARE AND ATTENTION

YES NO

III - GENERAL DATA

II - CONDITION OF VALVE

TEST SATISFACTORY (If not, why?)

YES NO

TYPE

WATER MOTOR ELECTRIC LOCAL CENTRAL

ALARM

TEST SATISFACTORY (If not, why?)

YES NO

ACCELERATOR OR EXHAUSTER

DID VALVE LEAK AT ANY POINT WHEN TRIPPED (If so, where?)

YES NO

VALVE TESTED WITH

ACCELERATOR EXHAUSTER

CONTROLLING VALVE (During Test)

WIDE CRACKED OPEN SHUT

TEST DATA

I - DRY PIPE VALVE

For use of this form, see TM 5-695; the proponent agency is Office of the Chief of Engineers.

ANNUAL DRY PIPE VALVE INSPECTION AND TRIPPING TEST

DA FORM 3943, OCT 72 REPLACES DA FORM 5-118, 1 APR 47, WHICH WILL BE USED. USAPPC V1.00

NO. OF SPRINKLERS ON SYSTEM

DATE

BUILDING NO. SYSTEM NO. VALVE NO.

MANUFACTURER

SIZE

AIR PRESSURE AT LEAK POINT AIR PRESSURE AT TRIP POINT

TIME TO TRIP TIME TO GET WATER TO INSPECTOR'S TEST VALVE

MANUFACTURER

TYPE OR MODEL YEAR MFG.

GENERAL CONDITION

INSTALLATION

TYPE OR MODEL YEAR MFG.

LOCATION INSPECTOR

AIR PRESSURE WATER PRESSURE

VALVE FACE AND SEAT RINGS CORROSION OR INCRUSTATION

VALVE TRIPPED OR OPENED (By whom) VALVE RE-SET (By whom)

WAS INSPECTOR'S GAUGE USED OR CORRECTIONS MADE FOR GAUGE ERRORS?