5
FloodSafe
®
Inflow Preventer
TEST AND MAINTENANCE REPORT
OWNER: _________________________________________________________________________________
ADDRESS: ________________________________________________________________________________
LOCATION OF ASSEMBLY: __________________________________________________________________
MANUFACTURER: _________________________ MODEL NO: ____________________________________
YEAR OF MANUFACTURE: _______________________ SIZE: ____________________________________
PROCEDURE: See “FIELD TESTING THE FLOODSAFE” in the Instruction Manual.
1. Isolation Valve
Under Air Valve
2. Inflow Preventer Test
Lower Chamber
3. Inflow Preventer Test
Upper Chamber
□ leaked or
□ closed off tight
□ test cocks OK or
□ test cocks replaced
□ open test cocks
□ test cock OK or
□ test cock replaced
Record any maintenance
performed:
Initial
Tests:
□ Connect test pipe assembly
to test cock A.
□ Fill lower chamber and test
pipe with clean water.
□ Maintain water level above
“Minimum Test Level”
□ Connect test pipe assembly
to test cock B.
□ Fill upper chamber and test
pipe with clean water.
□ Maintain water level above
“Minimum Test Level”
Inflow Preventer Basket
□ removed and cleaned
□ Observe test cock B for
leakage for 5 minutes.
□ Observe test cock C for
leakage for 5 minutes.
Any sign of leakage from test
cock is cause for rejection.
□ Pass □ Fail
Any sign of leakage from test
cock is cause for rejection.
□ Pass □ Fail
Bottom Plug
□ installed
Repairs:
Record maintenance
performed:
Record maintenance
performed:
Final
Tests
(when
needed):
If initial test failed, repeat 5
minute test. Any sign of
leakage from test cock B is
cause for rejection.
□ Pass □ Fail
If initial test failed, repeat 5
minute test. Any sign of
leakage from test cock C is
cause for rejection.
□ Pass □ Fail
IMPORTANT:
□ After testing, reopen the isolation valve under the air valve.
NOTE: All repairs and final tests should be completed within five (5) working days.
COMMENTS: _______________________________________________________________________________
___________________________________________________________________________________________
I hereby certify that this data is accurate and reflects the proper maintenance of the assembly.
TESTER: _____________________________ CERT No. __________________ DATE: __________________
TIME: ___________________
THIS ASSEMBLY: □ Passed □ Failed
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