YES YES YES YES YES YES NO NO NO NO NO NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping tested utilizing distilled water at specified pressure and duration as per specification. All leaks identified during testing have been repaired and test re-done until no leaks are present. Test conducted with all piping of tested system or section visible during testing. Entire testing procedure witnessed by DFD representative. After pressure testing system filled and disinfected with solution of distilled or RO water and hydrogen peroxide per manufacturer directions. Following initial disinfection system flushed with distilled or RO water until no trace of hydrogen peroxide evident by potassium permanganate test. Negative Responses Date Found Date Found By Location Reason for Negative Response Resolved Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO E) FINALIZATION CHECKS Questions (See details below) % Date Description of Work Performed Complete Initials 1) 2) 3) 4) YES YES YES YES NO NO NO NO YES YES YES YES NO NO NO NO YES YES YES YES NO NO NO NO YES YES YES YES NO NO NO NO YES YES YES YES NO NO NO NO
YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping tested utilizing distilled water at specified pressure and duration as per specification. All leaks identified during testing have been repaired and test re-done until no leaks are present. Test conducted with all piping of tested system or section visible during testing. Entire testing procedure witnessed by DFD representative. After pressure testing system filled and disinfected with solution of distilled or RO water and hydrogen peroxide per manufacturer directions. Following initial disinfection system flushed with distilled or RO water until no trace of hydrogen peroxide evident by potassium permanganate test. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO E) FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
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