Fire Hydrants/ Fire Hose Commissionning - Technical Acceptance Report

Country: Site's representatives(2): Contracting Company:

Site: External Assesssor: Contractor's Representative:

Verification Compliance CAPA

Equipment Parameter Testing Item checked / tested Uom
Target Actual Yes No Observations Further action
Tank Volume As per requirement m3 ?? 98KL ? ?
Water
Management Level &Gauge measurement Yes/No Yes Yes Yes No
Water
Automatic water refill Yes/No Yes Yes Yes No
Jokey pump outlet pressure Bar ?? 9
Fire Pump Pressure testing Electrical Pump outlet pressure Bar ?? 11
Diesel Pump outlet pressure Bar ?? 11
Hose Reel 1 m 30 30 Yes
Measuring Hose Reel 2 m 30 30 Yes
individual Hose Hose Reel 3 m 30 30 Yes
length Hose Reel 4 m 30 30 Yes
Hose Reel 5 m 30 30 Yes
Hose Reel 1 m 30 17
Hose Reel 2 m 30 17
Testing individual
Hose reels testing Jet distance Hose Reel 3 m 30 17
Hose Reel 4 m 30 17
Hose Reel 5 m 30 17
Hose Reel 1 Bar 9.5 9
Hose Reel 2 Bar 9.5 9
Checking individual
pressure at Target Hose Reel 3 Bar 9.5 9
Hose Reel 4 Bar 9.5 9
Hose Reel 5 Bar 9.5 9
General Comments

Safety Executive Site Maintenance Executive PSO

Date and signature for
Equipment Date / Name / Signature for Acceptance Date / Name / Signature for Acceptance Validation
Acceptance and
HandOver
 Fire Hydrants/ Fire Hose Commissionning - Affirmative Check List

Country: Site's representatives(2): Contracting Company:

Site: External Assesssor: Contractor's Representative:

Equipment Compliance CAPA
Parameter Testing Item checked / tested
Yes No Observations Further action
Water Management Tank Volume is designed as per requirement Yes
Water Level in the tank is visualized by a gauge Yes
Water level in the tank is automaticcally monitored, and low level Yes
constantly proceed refill or triggers an alarm
Water Supply and Water outlet valve from the tank is secured on *OPENED* Yes
Control position
Water supply valves to the 3 pumps are secured on *OPENED*
Yes
position

Fire Pump Jokey pump starts to keep constant pressure (----bar) in the fire 9
pipes network
Electrical Pump starts to set fire fighting pressure at --------bar 11
Pressure testing Diesel Pump starts automatically when electric pump is not
11
available and maintain the fire fighting pressure at ------bar
There is an Alarm system that triggers when water pressure is
No
increasingly low in the network
Water Jet testing on Hose Hose Reel 1 Water jet is ajustable ?????? Yes
Reels Hose Reel 2 Water jet is ajustable ?????? Yes
Hose Reel 3 Water jet is ajustable ?????? Yes
Hose Reel 4 Water jet is ajustable ?????? Yes
Hose Reel 5 Water jet is ajustable ?????? Yes
Pressure testing on Hose
Reels Hose Reel 1 Pressure is visible and good enough to favor fire extinction ?????
Yes
Hose Reel 2 Pressure is visible and good enough to favor fire extinction ?????
Yes
Hose Reel 3 Pressure is visible and good enough to favor fire extinction ?????
Yes
Hose Reel 4 Pressure is visible and good enough to favor fire extinction ?????
Yes
Hose Reel 5 Pressure is visible and good enough to favor fire extinction ?????
Yes
General Comments

Safety Executive PSO

Date / Name / Signature for Acceptance Date and signature for Validation
Equipment Acceptance and
HandOver