Checklist for Annual Inspection and Test of Fire pump components "*" indicates required fields Form Number: 2025/TS/QA/Ch/069 This field is hidden when viewing the formEmployee ID*This field is hidden when viewing the formEmployee Name*This field is hidden when viewing the formPosition Description*This field is hidden when viewing the formPhone Number*This field is hidden when viewing the formDepartment*CEO Office Section*This field is hidden when viewing the formEM Section*This field is hidden when viewing the formOperations Section*This field is hidden when viewing the formHR , ADMIN & IT Section*This field is hidden when viewing the formHSE Section*This field is hidden when viewing the formFinance Section*This field is hidden when viewing the formTS Section*This field is hidden when viewing the formCOD Section*MECHANICAL CHECKS Pump Identification Number Diesel Fire Engine Pump (GA-111 A) YESNONA Status Remarks Main Electrical Pump (GA-111 B) YESNONA Status Remarks Jockey Fire Pump-01(GA-112 A) YESNONA Status Remarks Jockey Fire Pump-02 (GA-112 B)* YESNONA Status Remarks Pump in Service on inspection Date Diesel Engine Pump YESNONA Status Remarks Main Electrical Pump* YESNONA Status Remarks Jockey Pump-01* YESNONA Status Remarks Jockey Pump-02 YESNONA Status Remarks Casing drain line Free of DamageDiesel Fire Engine Pump YESNONA Status Remarks Main Electrical Pump YESNONA Status Remarks Jockey Fire Pump-01 YESNONA Status Remarks Jockey Fire Pump-02 YESNONA Status Remarks Casing Pressure Relief valve free of damageDiesel Fire Engine Pump YESNONA Status Remarks Main Electrical Pump YESNONA Status Remarks All Valves ,Fittings, Pipes are leak tight YESNONA Status Remarks Jockey pump1 & 2 appears properly aligned YESNONA Status Remarks Jockey pump 1 & 2 suction valves open YESNONA Status Remarks Jockey pump 1 & 2 discharge valves open YESNONA Status Remarks Electrical & Diesel pumps suction valves open & wheel lock available YESNONA Status Remarks Electrical & Diesel pumps Discharge valves open & wheel lock available YESNONA Status Remarks Diesel engine diesel tank diesel level accepted YESNONA Status Remarks All Fire pump shaft coupling appears properly aligned YESNONA Status Remarks All pumps Gland Packing area with no water leakage YESNONA Status Remarks Main Header line Pressure Relief valve of the Complete System free of damage YESNONA Status Remarks Relief valve pressure appears properly adjusted YESNONA Status Remarks Flow meter Isolation valves closed & Locked YESNONA Status Remarks ELECTRICAL CHECKSFire Pump Controller Power ON Diesel Fire Engine Pump YESNONA Status Remarks Main Electrical Pump YESNONA Status Remarks Jockey Pump Controller power "ON" YESNONA Status Remarks Jockey Pump Controller set on "AUTO" YESNONA Status Remarks Weekly test run records available YESNONA Status Remarks Date of last pump run test* MM slash DD slash YYYY INSTRUMENTATION CHECKSDiesel Fire pump run for 30 minutes YESNONA Status Remarks Automatic start function properly YESNONA Status Remarks Automatic start set pressure for Diesel pump 50.75 psi YESNONA Status Remarks Manual Start function properly YESNONA Status Remarks Manual Stop function properly YESNONA Status Remarks Main Electrical Fire pump run for 10 minutes YESNONA Status Remarks Automatic start function properly YESNONA Status Remarks Automatic start set point for electric pump 73.95 psi YESNONA Status Remarks Manual start function properly YESNONA Status Remarks Manual Stop function properly YESNONA Status Remarks Timer indicates total run time _____ HrsJockey pump 1 turn on set point 8.3 Kg/cm2 YESNONA Status Remarks Jockey pump 1 turn off set point 10.00 Kg/cm2* YESNONA Status Remarks Jockey pump 2 turn on set point 7.3 Kg/cm2 YESNONA Status Remarks Jockey pump 2 turn off set point 10.00 Kg/cm2 YESNONA Status Remarks PERFORMANCE CHECKSFire pump electrical power readings recorded at each flow conditionMain Electrical pump At rated flow (2000 gpm)* Flow Readings (USGPM) Ampere Readings Pressure Pressure (PSI) Design pressure Main Electrical pump At 150 % flow (3000 gpm)* Flow Readings (USGPM) Ampere Readings Pressure Pressure (PSI) Design pressure Fire pump Diesel engine readings recorded at each flow conditionDiesel Engine At rated flow (2000 gpm)Design pressureFlow ReadingTemp. ReadingsPressure measuredRPMAt rated flow (2000 gpm) - rpmDesign pressureFlow ReadingTemp. ReadingsPressure measuredRPMDiesel Engine At 150 % flow (3000 gpm)Design pressureFlow ReadingTemp. ReadingsPressure measuredRPMAt 150 % Flow (3000 gpm) - rpmDesign pressureFlow ReadingTemp. ReadingsPressure measuredRPM
