Therma-Flow
®
PLUS
IOM 09900002 Revision C 08/15/21
© 2021, Encon Safety Products, Inc.
3.5 Therma-Flow
®
Plus Inspection Report
DATE
AREA
TAG
NUMBER
MODEL
NUMBER
SERIAL
NUMBER
I. VISUAL INSPECTION
UNIT VISIBILITY
ENCLOSURE PROVIDES A MIN. UNOBSTRUCTED AREA OF 34” (86.4 cm) IN DIAMETER
AREA FREE OF DEBRIS (Within 10 seconds from hazard, Out of potential spray path)
AREA LIGHT/ALARM LIGHT/INTERIOR LIGHT
SIGN CONDITION
EYEWASH COVERS ATTACHED AND IN PLACE ON NOZZLES
SHOWER POSITIONED TO PROVIDE FLUID PATTERN HEIGHT AT MIN. 82” – MAX. 96” FROM STANDING LEVEL
EYEWASH (Min. 33” – Max. 45” from standing level and min. 6” from nearest obstruction)
VALVES (q Leaking: Eyewash Shower Drench Hose)
ACTUATORS EASILY LOCATED AND READILY IDENTIFIABLE
PULL ROD NO GRATER THAN 69” FROM STANDING LEVEL
INSULATION AND COVERS (q Adjustment q Replacement)
HEAT TRACE INDICATOR LIGHT (q On q Off) if applicable
FREEZE / SCALD PROTECTION VALVES (q Leaking: F.P. Valve S.P. Valve)
OK NO
II. OPERATIONAL INSPECTION
SHOWER VOLUME (Min. 20 gpm / 75.7 lpm)
SHOWER PATTERN TEST (20” diameter pattern 60” from standing level)
SHOWER VELOCITY, NONINJURIOUS TO USER (q Too High q OK)
EYEWASH VOLUME (Min. 0.4 gpm / 1.5 lpm)
EYEWASH PATTERN TEST
EYEWASH VELOCITY, NONINJURIOUS TO USER (q Too High q OK)
STAY OPEN VALVES “OFF” TO “ON” IN ONE SECOND OR LESS COMPONENTS
OPERATE SIMULTANEOUSLY TO ANSI REQUIRMENTS
ALARM TEST Local: Shower q OK q No; Eyewash q OK q No; Drench Hose q OK q No
Remote: Shower q OK q No; Eyewash q OK q No; Drench Hose q OK q No
SUPPLY WATER PRESSURE (Min. 30 psig / 207 kPag):
WATER TEMPERATURE (78° to 92°F / 25.6° to 33.3°C):
OK NO
Comments:
Corrective
action required to the shower/shower parts to place unit in operational readiness state:
Action required other than to the shower/shower parts to correct operation:
Report sent to: q Maintenance for action q Record keeping
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