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Interactive Fire Protection Form

Underground Pipe Inspection Certificate

Complete the contractor's underground piping material and test information below. Use Print / Save as PDF when you are ready to create the completed certificate.

Contractor's Material & Test Certificate for Underground Piping

OKIE Safety Consulting

Project & Approval Information

Plans

Installation conforms to accepted plans
Equipment used is approved

Instructions & Turnover

Person responsible for fire equipment has been instructed on control-valve location and care/maintenance of new equipment
Required care and maintenance instructions / charts have been left on the premises

Underground Pipe & Joints

Pipe conforms to applicable standard
Fittings conform to applicable standard
Joints requiring anchorage are clamped, strapped or blocked per applicable standard

Flushing Tests

New underground piping flushed in accordance with the applicable standard
Lead-ins flushed in accordance with the applicable standard

How flushing flow was obtained

Through what type of opening

Hydrostatic & Leakage Tests

Joints Covered

Forward Flow / Backflow Prevention

Forward-flow test performed in accordance with the applicable requirement

Hydrants & Control Valves

All Operate Satisfactorily
Water control valves left fully open
Fire department connection / hydrant hose threads are compatible with responding fire department hose

Remarks & Signatures

This web form organizes the project and test information from the supplied underground piping certificate. The contractor remains responsible for completing all tests and documentation required by the applicable adopted standard and authority having jurisdiction.
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