FORM FOR INSPECTION, TESTING AND …

1 FORM for inspection , TESTING AND maintenance OF fire PUMPS DIESELI nformation on this form covers the minimum requirements of NFPA 25-1998 for centrifugal firepumps. This form does not relieve the owner of the responsibility of complying with the otherrequirements of NFPA 25-1998 for the inspection , TESTING and maintenance of fire :_____ Owner s Phone Number: _____Owner's address:_____Property being evaluated:_____Property address:_____Date of work:_____ All responses refer to the current inspection performed on this inspection is: (check one) __ Weekly __ Monthly __ Quarterly __ Semiannual __ AnnualNote:1. All questions are to be answered yes, no, or not applicable. All "No" answers are to be in the comment potion of this form. 2. Inspections are to be performed with water supplies (including fire pumps) in service, unless the impairment procedures of Chapter 11 of NFPA 25 are I - Owner's the fire pump in service?

2 ___Yes ___No ___ the fire pump remained in service since the last inspection ?___Yes ___No ___ the system (of which the fire pump is a part) free from actuation of devices oralarms since the last inspection ?___Yes ___No ___N/ANote to owner: A preventive maintenance program for the diesel engine driver shall be established in accord ance with themanufactures requirements and or representative (print name)Signature and date_____Part II - Inspector's - All to be performed house/room at least 40 degrees Fahrenheit?___Yes ___No ___ house/room for diesels without engine heaters at least 70 degrees Fahrenheit?___Yes ___No ___ louvers free to operate?___Yes ___No ___ , discharge and bypass valves open? ___Yes ___No ___ free from leaks?___Yes ___No ___ and system pressure gauges normal?___Yes ___No ___N/A Record suction _____ and discharge _____ pressure while not reservoir, if provided, full?

3 ___Yes ___No ___ indicating power "ON"?___Yes ___No ___ tank at least two thirds full?___Yes ___No ___ selector switch in Auto position?___Yes ___No ___N/APage 2D of voltage and readings normal?___Yes ___No ___ charging current readings normal?___Yes ___No ___ indicators "ON" or failure indicators "OFF"? ___Yes ___No ___ alarm indicators "OFF"___Yes ___No ___ engine running time meter Is thisappropriately higher than previous reading? ___Yes ___No ___ oil level normal?___Yes ___No ___ water level normal?___Yes ___No ___ level in batteries normal?___Yes ___No ___ terminals free from corrosion?___Yes ___No ___ heater operating?___Yes ___No ___ level in right angle gear drive normal?___Yes ___No ___ test items by qualified operating personnelDiesel Engine - Driven started automatically?___Yes ___No ___N/APump starting pressure.

4 _____ run for at least 30 minutes?___Yes ___No ___N/ARecord suction _____ and discharge _____ pressure while packing gland showing slight discharge?Have adjusted if necessary by spkr. contractor?___Yes ___No ___ from unusual noises or vibrations?___Yes ___No ___ boxes, bearings and pump casing free fromoverheating?___Yes ___No ___ time for engine to crank. time for engine to reach running speed. oil pressure gauge, speed indicator, water and oiltemperature indicators all reading normal?___Yes ___No ___ water flowing from heat exchanger?___Yes ___No ___ relief valves operating with proper pressure downstream while pumpis operational?___Yes ___No ___ times and pressures in Part B acceptable?___Yes ___No ___ test items by Licensed Sprinkler alarm supervisory conditions simulated?___Yes ___No ___N/AAll alarm supervisory conditions operated?___Yes ___No ___N/AFORM for inspection , TESTING AND maintenance OF fire PUMPS DIESELPage 3D of 6 tests items by Licensed Sprinkler fire pump assembly control valve supervisory tamper devices tested?

5 ___Yes ___No ___ tests by Licensed Sprinkler ContractorsAnnual pump test was run using the following method: (Check one)___Method A. Discharge of flow through hose readings taken at each hose B. Discharge through by-pass flow meter to drain or suction reservoir. Flow readings taken by flow C. Discharge through by-pass flow meter directly returned to pump readings taken by flow : At least once every three years method A or B must be TEST RESULTS : Attach copy of fire pump flow test results to include pump speed Are the values in the fire Pump test results acceptable?___Yes ___No ___N/ANo flow (churn) test run for 30 minutes?___Yes ___No ___N/ACirculation relief valve and/or pressure relief valve operated properly during all flow tests?

6 ___Yes ___No ___N/ANo alarm indicators or other visible abnormalities observed during no-flow test?___Yes ___No ___ suction throttling device suction pressure simulated?___Yes ___No ___N/AFree from abnormalities in throttling action? ___Yes ___No ___ from abnormalities in return to full flow?___Yes ___No ___N/AC. maintenance items by qualified personnelNote: A maintenance schedule must be established in accordance with the manufactures instruction s. In the absence of such aschedule, the following must be used:1. Weekly maintenance itemsA. Fuel tank level, tank float switch, and solenoid valve operation Acceptable? ___Yes ___No ___N/AB. Diesel fuel system free of water?___Yes ___No ___N/AFORM for inspection , TESTING AND maintenance OF fire PUMPS DIESELPage 4D of 6C. Flexible hose and connectors in fuel and coolant systems acceptable?

7 Drive belts acceptable?___Yes ___No ___N/AD. Oil level and lube oil heater acceptable?___Yes ___No ___N/AE. Coolant level acceptable?___Yes ___No ___N/AF. Water pump for coolant system operating?___Yes ___No ___N/AG. Jacket water heater for coolant system ___Yes ___No ___N/Aacceptable?H. Exhaust system free of leakage?___Yes ___No ___N/AI. Drain condensate trap on exhaust system operational?___Yes ___No ___N/AJ. Electrolyte level in batteries acceptable?___Yes ___No ___N/AK. Connections to electrical system acceptable?___Yes ___No ___N/A maintenance items A. Battery case clean, dry and free of corrosion?___Yes ___No ___N/AB. Batteries specific gravity or state of charge passed test?___Yes ___No ___N/AC. Charger and charge rate passed visual inspection ?___Yes ___No ___N/AD. Battery charge being equalized?___Yes ___No ___ maintenance items A.

8 Cleaned strainer, filter or dirt leg in diesel fuelsystem?___Yes ___No ___N/AB. Cleaned or replaced crank case breather in lubrication system?___Yes ___No ___N/AC. Cleaned water strainer in coolant system?___Yes ___No ___N/AD. Insulation acceptable and fire hazards eliminatedfrom exhaust system?___Yes ___No ___N/AE. Battery terminals clean and tight?___Yes ___No ___N/AF. Electrical system free of wire chafing?___Yes ___No ___ tank free of water and foreign material?___Yes ___No ___ maintenance items A. Manual starting means operated?___Yes ___No ___N/AB. Antifreeze tested in coolant system?___Yes ___No ___N/AC. Flexible exhaust section acceptable?___Yes ___No ___N/AD. Boxes, panels and cabinets on electrical systemscleaned?___Yes ___No ___N/A5. Annual maintenance itemsA. Check pump bearing lubrication?___Yes ___No ___N/AB. Shaft end play acceptable?

9 ___Yes ___No ___N/AFORM for inspection , TESTING AND maintenance OF fire PUMPS DIESELPage 5D of 6C. Pump coupling alignment acceptable?___Yes ___No ___N/AD. Transmission coupling and mechanical movingparts lubricated?___Yes ___No ___N/AE. Electrical connections secure?___Yes ___No ___N/AF. Pressure switch settings calibrated?___Yes ___No ___N/AG. Pump and Motor bearings greased?___Yes ___No ___N/AH. Fuel tank free of water, sediment and foreign material? ___Yes ___No ___N/AI. Tank vents and overflow pipes free of obstructions?___Yes ___No ___N/AJ. Fuel piping acceptable?___Yes ___No ___N/AK. Oil, oil filters and fuel filters changed in diesel systems? ___Yes ___No ___N/AL. Antifreeze changed in coolant system?

10 ___Yes ___No ___N/AM. Heater exchanger cleaned out?___Yes ___No ___N/AN. Duct work & louvers (combustion air) acceptable?___Yes ___No ___N/AO. Exhaust system free of back pressure?___Yes ___No ___N/AP. Exhaust system hangers and supports acceptable?___Yes ___No ___N/AQ. Control and power wirings tight?___Yes ___No ___ diesel fuel sample tested annually for compliancewith ASTM D-975, standard for diesel fuel?___Yes ___No ___ diesel fuel treated for stability and control ofmicrobial growth?___Yes ___No ___N/AT. Jockey Pump: Cut-in____ psi., Cut-out____ III - Comments (Any "No" answers, test failures or other problems found with the fire pump must beexplained here.)_____Form Date 10/30/03 FORM for inspection , TESTING AND maintenance OF fire PUMPS DIESELPage 6D of 6 Part IV - Inspector's InformationInspector:_____Company:_____ Company's address:_____I state that the information on this form is correct at the time and place of my inspection , and that all equipment atthis time was left in operational condition upon completion of this inspection except as noted in Part III of Inspector: _____ Date: _____Form Date 10/30/03 FORM for inspection , TESTING AND maintenance OF fire PUMPS DIESEL