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    Safety Checklist Hydrant Box Form

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    Rishad Fadilah
    This document contains a safety checklist form for inspecting hydrant boxes. The form includes sections for the date, time of inspection, hydrant box number, standard conditions, actual conditions, and remarks. It is used to record the condition of each hydrant box component, including the box itself, seal pin, hoses, nozzles, and supply valves. The inspector and approver must sign the form, and any damage is to be noted in an attached report.

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    Safety Checklist Hydrant Box Form

    Uploaded by

    Rishad Fadilah
    6 views1 page
    This document contains a safety checklist form for inspecting hydrant boxes. The form includes sections for the date, time of inspection, hydrant box number, standard conditions, actual conditions, and remarks. It is used to record the condition of each hydrant box component, including the box itself, seal pin, hoses, nozzles, and supply valves. The inspector and approver must sign the form, and any damage is to be noted in an attached report.

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    SAFETY CHECKLIST HYDRANT BOX FORM

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    This document contains a safety checklist form for inspecting hydrant boxes. The form includes sections for the date, time of inspection, hydrant box number, standard conditions, actual conditions, and remarks. It is used to record the condition of each hydrant box component, including the box itself, seal pin, hoses, nozzles, and supply valves. The inspector and approver must sign the form, and any damage is to be noted in an attached report.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    6 views1 page

    Safety Checklist Hydrant Box Form

    Uploaded by

    Rishad Fadilah
    This document contains a safety checklist form for inspecting hydrant boxes. The form includes sections for the date, time of inspection, hydrant box number, standard conditions, actual conditions, and remarks. It is used to record the condition of each hydrant box component, including the box itself, seal pin, hoses, nozzles, and supply valves. The inspector and approver must sign the form, and any damage is to be noted in an attached report.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 1

    SAFETY CHECKLIST HYDRANT BOX FORM

    Date: Time Checking: 3 Month

    A. HYDRANT BOX STANDARD ACTUAL CONDITION REMARKS


    No. HB
    Hydrant Box Condition Good Good Not Good
    Seal Pin Available Available Not Available
    Hose ( …..m ) 1,5 " Available Available Not Available
    Nozzle 1,5 Available Available Not Available
    Supply valve 1.5" Available Available Not Available
    Supply valve 2.5" Available Available Not Available

    Inspect By Approved By

    Fire Life Safety Supervisor Loss Prevention Manager

    Note :
    - The "ACTUAL CONDITION" Coloumn fill by marks ( √ )
    - If there is damage to the tool/material make a damage report by attaching this form.
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    SAFETY CHECKLIST HYDRANT BOX FORM

    Date: Time Checking: 3 Month

    A. HYDRANT BOX STANDARD ACTUAL CONDITION REMARKS


    No. HB
    Hydrant Box Condition Good Good Not Good
    Seal Pin Available Available Not Available
    Hose ( …..m ) 1,5 " Available Available Not Available
    Nozzle 1,5 Available Available Not Available
    Supply valve 1.5" Available Available Not Available
    Supply valve 2.5" Available Available Not Available

    Inspect By Approved By

    Fire Life Safety Supervisor Loss Prevention Manager

    Note :
    - The "ACTUAL CONDITION" Coloumn fill by marks ( √ )
    - If there is damage to the tool/material make a damage report by attaching this form.

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