Format No JI/EHS/0015

Checklist – Date 02/11/2020

Water Cum Foam Monitor Rev. No. 00

Date of Inspection:

A Fire Water Monitor B Pick Up Tube Assembly

1 Is operation of butterfly valve easy?
2 Is operation of 360-degree lever easy?
3 Is 360 rotation – free and easy?
4 Is up and down movement – free and easy?
5 Is operation of drain valve easy?
Is condition of monitor okay? (free from corrosion,
6
damage/defect, properly painted etc.)
7 Is there any sign of chocking observed?
Is every monitor is permanently numbered and
8
legible?
Is tube assembly properly clamped and without
1
sign of corrosion / damage?
2 Is tube free from chocking?
3 Is operation of valve easy?
Is condition of PVC pipe free from
4
damage/puncture/twist/bend etc.?
Is 3% FFF Foam Compound - 200 liter available
C at every Water cum Foam Monitor post?
D Other

Inspection: -

Deficiency List
SN FM No. Exact Location (Simply list out by No e.g. Remark
A1, B2, C3 …)

Name Signature Date

Inspected by

Corrective Actions Identified, if any: -

SN Action Item Responsibility

Prepared By Reviewed By Approved By

Name
Signature
Date