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Company Name Lakewood, WA 98000 253-000-0000
SYSTEM #
FIRE PUMP SYSTEM
INSPECTION AND TESTING REPORT
| Inspector |
| City, State, Zip |
Monitoring Entity
Company
Phone
Authority Having Jurisdiction
Service: |_| Quarterly |_| Semi-Annually |_| Annually
Fire Pump type; electric |_| diesel |_| controller voltage without load with 100% load
| 2 YEAR, Control Valves, operate and lubricate valve to endure operability. |
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| 2 YEAR, Controllers, calibrate pressure switches. |
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| 2 YEAR, Controllers, exercise circuit breakers and switches to verify operability. |
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| 2 YEAR, Controllers, inspect fuses. |
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| 2 YEAR, Pumps, check coupling alignment to ensure that the shaft is aligned. |
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| 2 YEAR, Pumps, check pump shaft end play. |
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| 2 YEAR, Pump, lubricate bearings. |
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| 2 YEAR, Pump, lubricate couplings. |
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| 2 YEAR, Pump, lubricate right angle drives. |
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| 2 YEAR, Fuel, sample fuel to verify quality. |
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| 2 YEAR, Relief Valves, calibrate valves. |
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| 2 YEAR, Emergency Power Supply, test to verify availability and capability for pump motor. |
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| 5 YEAR, Pump, conduct flow test to verify pump output |
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| 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
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 |
