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Revision Date: 10/12/21
Scott Air-Pak 75 SCBA INSPECTION LOG
Scott AIR-PAK 75 4.5
Inspection Form
Date: ____ / ____ / ____
Name of Person Inspecting: ____________________________________
Location (circle):
EHS Vehicle 1446
LNF
INSPECTION OF THE BREATHING AIR CYLINDER
U-M EHS # (
CIRCLE
): 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PASS FAIL
Visually inspect breathing air cylinder and valve assembly for physical
damage such as dents or gouges in metal or in composite wrapping.
Cylinders which show physical damage or
exposure to high heat or flame,
such as paint turned brown or black, decals charred or missing, pressure
gauge lens melted or elastomeric bumper distorted, and cylinders which
show evidence of exposure to chemicals such as discoloration, cracks in the
cylinder or
the composite wrapping, peeling of the outer layers of the
composite wrapping and/or
bulging of the cylinder wall, shall be removed
from service and emptied of compressed air.)
_____
_____
Hydrostatic test date is current (within 5 years)
_____ _____
Check for damage of the cylinder valve hand wheel and the threads on the
cylinder valve outlet.
_____ _____
Check the relief valve (burst disc) for damage or dirt.
_____ _____
Check the cylinder pressure gauge for “FULL” indication. If
cylinder pressure
is less than “FULL,” replace with a fully charged cylinder.
_____ _____
Complete one form for each breathing air cylinder.
This form shall be completed monthly and after every use.
Any checked “fail” shall result in the SCBA being bled of all air, taken out of service, tagged, and
the Office of Emergency Preparedness (OEP) notified.
