Fire Pump Checklist

Environmental Health and Safety

To Service Provider: Fill out this form while m aking the inspection. Send the
completed form to your contract manager who will forward to Environm ental Health and
Saf ety. T he r epor t shall be held f or r eview b y Env ir onm ental Health and Saf ety an d/or
FM Global Loss Prevention Consultant.

LOCATION INSPECTION

Building: Name of Inspector:

Location: Date:

Date of Installation: Signature:

MONTHLY INSPECTION

1. Is housekeeping good around all

Yes No If no, explain.
equipment?

2. Is temperature within the room or area

Yes No If no, explain.
above 40° F?

3. Are pump suction, discharge and

bypass valves secured in the open
Yes No If no, explain.
position with a pad lock and sturdy
chain?

4. Were pump suction and system

Yes No Suction psi System psi
pressure gauges recorded?

5. Are there any leaks around piping? Yes No If yes, explain.

6. Is electric controller switch in the “on”

Yes No If no, explain.
position and pilot light illuminated?

MONTHLY TEST: Automatically start the fire pump via pressure drop and perform items 1 through 7.

1. Was isolating switch and circuit breaker

Yes No If no, explain.
exercised?

2. What was the pump starting pressure? psi

3. How long did it take for the motor to

minutes seconds
accelerate to full speed?
4. What were the system suction and
Suction psi Discharge psi
discharge pressure gauge readings?

5. Were pump packaging boxes, bearings

Yes No If yes, explain.
and pump casing overheating?

6. Are circulation relief valves operating?

Yes No If no, explain.

7. Is there unusual noise or vibration? Yes No If yes, explain.

Run the electric motor drive unit for a minimum of five minutes and then perform items 8 through 11.

8. Are there any temporary repairs to be

Yes No If yes, explain.
reported?

9. Are there any unsafe conditions

including missing or damaged safety Yes No If yes, explain.
guards?

10. Were deficiencies documented and

reported to Safety and Environmental Yes No If no, explain.
Affairs?

11. Was inspection documentation

forwarded to Safety and Environmental Yes No If no, explain.
Affairs?

COMMENTS