Motor Run connected? _____Yes _____ No
Power Available connected? _____Yes _____ No
Phase Reversal connected? _____Yes _____ No
Other contacts supplied and connected? _____Yes _____ No
Tornatech Controller S/N: _________________________________________
Installation address: _________________________________________
_________________________________________
Field Acceptance Test completed? _____Yes _____ No
Field Acceptance completed by: __________________________________________
Company: __________________________________________
Date: __________________________________________
Witnessed By: __________________________________________
Company: __________________________________________
The undersigned witness has been made aware of the NFPA20 article 14.4 Periodic Inspection, Testing and
Maintenance which stipulates that “Fire pumps shall be inspected tested and maintained in accordance with
NFPA25 – Standard for the Inspection, Testing and Maintenance of Water Based Fire Protection Systems”
Comments: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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