FIRE HYDRANT INSPECTION FORM
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
Date
Client's Name
First Name
Last Name
Client's Signature
EVALUATIONS
Please choose the most appropriate option and fill in the blanks if necessary.
Fail
Pass
N/A
Notes
1) Hydrant does free from obstruction.
1
2
3
2) The equipment does in good condition.
4
5
6
3) Is there any leaks?
7
8
9
4) The equipment in the hydrant cabinet is complete. ( Refer to equipment list inside the cabinet)
10
11
12
5) Conduct a yearly full flush on the hydrant system. Water does come out steadily.
13
14
15
6) The hydrant does in a good condition.
16
17
18
7) Hydrant hydrostatic test results are between confidence intervals.
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20
21
8) Hydrant system flow test results are between confidence intervals.
22
23
24
9) Hydrant Test equipment/pressure gauges results are between confidence intervals.
25
26
27
10) Nozzles and other portable devices do in a good condition.
28
29
30
Findings & Comments
Inspector's Company Name
Inspector's Company Phone Number
Please enter a valid phone number.
Inspector's Name
First Name
Last Name
Inspector's Signature
Submit
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