SCBA Inspection Checklist Form
Document the inspection of a self-contained breathing apparatus (SCBA) using this comprehensive checklist.
Inspector Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SCBA Unit Identification Number
*
Visual Inspection Checklist
*
Rows
Pass
Fail
Facepiece condition
1
2
Harness/straps integrity
3
4
Cylinder valve and gauge
5
6
Hoses/connections
7
8
Backplate/frame
9
10
Cylinder Pressure (psi)
*
Alarm/Warning Device Functional?
*
Yes
No
N/A
Overall Cleanliness of SCBA
*
1
2
3
4
5
Comfort and Fit of Harness/Straps
*
Very Uncomfortable
1
2
3
4
Very Comfortable
5
1 is Very Uncomfortable, 5 is Very Comfortable
Breathing Apparatus Functionality
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Inspector Comments / Notes
Submit Inspection
Should be Empty: