• Regulator Inspection Form

  • Today's Date*
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  • Store or Customer Cylinder*
  • Date of Inspection / Service*
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  • Next Inspection Needed*
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  • Tests 1 - 6 to be completed while unit is pressurized to at least 3000psi

  • Test 1: Pressurized Immersion Test. Pressurize unit, submerge and look for leaks.
  • Test 2: Inter-stage Pressure (IP) Check. Check for stable pressure. IP =
  • Test 3: Opening Effort Primary 2nd Stage.
  • Test 4: Primary 2nd Stage operation of knobs/venture switches. All mechanisms should operate smoothly.
  • Test 5: Opening Effort Alternate 2nd Stage
  • Test 6: Alternate 2nd Stage operation of knobs/venture switches. All mechanisms should operate smoothly.
  • Test 7: 1st Stage Filter Inspection. Check for discoloration and debris.
  • Test 8: Primary 2nd Stage Negative Pressure Test. Inspect mouthpiece, purge and exhaust diaphragms.
  • Test 9: Alternate 2nd Stage Negative Pressure Test. Inspect mouthpiece, purge and exhaust diaphragms.
  • Test 10: Hose Inspection. Inspect hoses for cracks, damage at swages, crimping or blistering.

  • If regulator fails Test 1 through 6, service is required. If regulator fails 7 through 10, service is at technician’s discretion.

  • I certify that this inspection was done in accordance with prescribed guidlines per DOT,CGA,OSHA and PSI standards

  • Date
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  • Should be Empty: