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Special Hazard Routine Maintenance Monthly
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Person completing the testing
First Name
Last Name
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Site
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Date
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Date
Year
Month
Day
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Testing to be completed on this visit
Monthly
6 Monthly
Yearly
5 Yearly
Fire Alarm
Yes
No
N/A
Yes
No
N/A
Row 0, Column 0
Yes
No
N/A
Yes
No
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Row 0, Column 1
Yes
No
N/A
Yes
No
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Row 0, Column 2
Yes
No
N/A
Yes
No
N/A
Row 0, Column 3
Emergency Warning System
Yes
No
N/A
Yes
No
N/A
Row 1, Column 0
Yes
No
N/A
Yes
No
N/A
Row 1, Column 1
Yes
No
N/A
Yes
No
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Row 1, Column 2
Yes
No
N/A
Yes
No
N/A
Row 1, Column 3
Fire Extinguishers
Yes
No
N/A
Yes
No
N/A
Row 2, Column 0
Yes
No
N/A
Yes
No
N/A
Row 2, Column 1
Yes
No
N/A
Yes
No
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Row 2, Column 2
Yes
No
N/A
Yes
No
N/A
Row 2, Column 3
Fire Sprinklers
Yes
No
N/A
Yes
No
N/A
Row 3, Column 0
Yes
No
N/A
Yes
No
N/A
Row 3, Column 1
Yes
No
N/A
Yes
No
N/A
Row 3, Column 2
Yes
No
N/A
Yes
No
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Row 3, Column 3
Hydrants
Yes
No
N/A
Yes
No
N/A
Row 4, Column 0
Yes
No
N/A
Yes
No
N/A
Row 4, Column 1
Yes
No
N/A
Yes
No
N/A
Row 4, Column 2
Yes
No
N/A
Yes
No
N/A
Row 4, Column 3
Pumps
Yes
No
N/A
Yes
No
N/A
Row 5, Column 0
Yes
No
N/A
Yes
No
N/A
Row 5, Column 1
Yes
No
N/A
Yes
No
N/A
Row 5, Column 2
Yes
No
N/A
Yes
No
N/A
Row 5, Column 3
Fire Hose Reels
Yes
No
N/A
Yes
No
N/A
Row 6, Column 0
Yes
No
N/A
Yes
No
N/A
Row 6, Column 1
Yes
No
N/A
Yes
No
N/A
Row 6, Column 2
Yes
No
N/A
Yes
No
N/A
Row 6, Column 3
Gas System
Yes
No
N/A
Yes
No
N/A
Row 7, Column 0
Yes
No
N/A
Yes
No
N/A
Row 7, Column 1
Yes
No
N/A
Yes
No
N/A
Row 7, Column 2
Yes
No
N/A
Yes
No
N/A
Row 7, Column 3
Fire Alarm
Emergency Warning System
Fire Extinguishers
Fire Sprinklers
Hydrants
Pumps
Fire Hose Reels
Gas System
Monthly
Yes
No
N/A
Yes
No
N/A
Row 0, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 0, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 0, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 0, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 1, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 1, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 1, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 1, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 2, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 2, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 2, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 2, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 3, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 3, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 3, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 3, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 4, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 4, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 4, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 4, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 5, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 5, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 5, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 5, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 6, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 6, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 6, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 6, Column 3
Monthly
Yes
No
N/A
Yes
No
N/A
Row 7, Column 0
6 Monthly
Yes
No
N/A
Yes
No
N/A
Row 7, Column 1
Yearly
Yes
No
N/A
Yes
No
N/A
Row 7, Column 2
5 Yearly
Yes
No
N/A
Yes
No
N/A
Row 7, Column 3
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5
1.1 Electrical detection and control systems
Perform routine service in accordance with Section 6.
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6
1.2 Warning signs ( printed & labels )
CHECK that all warning signs are readily visible and legible
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1.3 Storage container enclosure
CHECK the storage container enclosure is accessible, adequately illuminated, ventilated and secured against unauthorized entry.
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1.4 Storage Containers
(a) CHECK that all containers are secure, accessible, free from damage and mounted to allow free passage of air around the base.
(b) CHECK each container pressure indicator and verify that any loss in pressure is not greater than 10% of the nominal charge pressure.
Where there is no container pressure indicator, check that the system discharge indicator has not operated (see Note 2).
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1.5 Mechanical Devices
(a) CHECK that all release anti-tamper seals/pull pins are in place and secure.
(b) CHECK that all release mechanisms, including gas container valves, actuators and drop weights, are undamaged, accessible and unimpede
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1.6 Lock off Valve
CHECK that the lock-off valve is correctly labelled and accessible.
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1.7 Protect Area
INSPECT the protected area to check that the risk has not changed from the approved design (e.g. volume, fuel type, change of use).
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Testing comments/Suggestions/Defects
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