2018 Wyoming Fire Equipment Inspection and Decontamination Report
Date: *
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DD
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YYYY
Location: *
Location where inspection was conducted
Your answer
Fire Code: *
Your answer
EQUIPMENT OPERATOR:
Equipment Description and ID (license plate, cache#, property tag #, other): *
Your answer
Agency/Department:
Your answer
Home Unit Location: *
Your answer
Person Responsible: *
Your answer
Name (and State) of Water Body Last Used for Drafting: *
Your answer
INSPECTION AND DECONTAMINATION PROCEDURE PERFORMED:
PROCEDURE PERFORMED UPON: *
Required
INSPECTION ONLY:
If there is no need for decontamination of equipment
Inspection Only Conducted:
Aquatic invasive species present?
Species (if known):
Your answer
Standing water present?
Location of standing water:
Where on/in the equipment was the standing water found
Your answer
DECONTAMINATION PROTOCOL:
HOT WATER:
Hot Water Temp:
Indicate what temperature was used for decontamination
Your answer
Hot Water Time:
Indicate duration of hot water decontamination
Your answer
Hot Water Location:
Indicate location on equipment that was decontaminated
Your answer
DECONTAMINATION PROTOCOL:
CHEMICAL:
Chemical Type:
Indicate what chemical and concentration were used
Your answer
Chemical Time:
Indicate duration of chemical treatment
Your answer
Chemical Location:
Indicate location on equipment that was decontaminated
Your answer
DECONTAMINATION PROTOCOL:
OTHER METHOD:
Other Type:
Indicate what type of method was used (scraping, physical removal, etc.):
Your answer
Other Time:
Indicate duration of other method of decontamination
Your answer
Other Location:
Indicate location on equipment that was decontaminated
Your answer
Additional Comments:
Your answer
FOOTVALVE TESTING:
Low pressure test conducted?
High pressure test conducted?
Explanatory comments:
Your answer
CLOSEOUT
Inspector Name:
Your answer
Inspector ID #
Your answer
Title:
Your answer
Phone:
Your answer
Equipment Operator:
I hereby authorize the state certified AIS inspector to decontaminate the above referenced fire equipment in accordance with state procedures.
Name:
Your answer
Date:
MM
/
DD
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YYYY
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