Updated: 4 October 2010

Date:______

COLLECTIVE PROTECTION SYSTEM CHECK SHEET

USS ______

REF:

a)PMS as listed

b)NSTM 470

COLLECTIVE PROTECTION SYSTEM (CPS)

1. Admin / IAW / YES/NO
a. Is the CPS Aerosal Penetration Certification Letter/ Message current? (Note date. Shall not exceed 4 years from current date.) / Ref (b)
b. Is the CPS PMS log current and correct? / 5121/017 M-6
2. CPS Fan Room (Dirty Side) / IAW / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U
a. Compartment Number
b. Are WTDs in proper working condition? / 1671/008
c. Is humidistat set to 70% relative humidity and working? / 5121/017
M-6
d. Are NSIFs properly installed and maintained per PMS requirements? (No disposable filters allowed!) / 5121/017
M-7
e. Are steam valves for preheaters in proper working condition? (if applicable)
f. Is preheater in proper working condition?
g. Is thermostat in proper working condition?
h. Are Bulkheads and Deck properly preserved?
i. Are prefilters installed and maintained per PMS requirements? / 5121/017 M-6
j. Are CBR gas and HEPA housing covers installed properly per PMS requirements? (None are loose, missing, no signs of leaks or improper assembly.) / 5121/017 M-6
k. Is Dirty Side Plenum free from obsticles/storage? / 5121/017 M-6
l. Are installed lighting systems functioning properly?
m. Are warning stickers reading “WARNING – DO NOT TOUCH THE CPS HEPA AND GAS COVER NUTS. TAMPERING WITH THESE NUTS WILL RESULT IN SYSTEM FAILURE.” installed? / Ref (b)
3. CPS Fan Room (Clean Side) / IAW / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U
a. Compartment and Zone Number
b. Are WTDs in proper working condition? / 1671/008
c. Is there evidence of cooling coil condensate or drain trap leakage into fan room?
d. Are CBR filter DP gages and gage lines installed correctly? / 5121/017 A-10
e. Are gages the correct type? (Range: 0-10” wg for CBR filter housings, 0-1” wg for NSIF) / 5121/017 A-10
f. Are gages Calibrated? (Date) / 5121/017 A-10
g. Annotate Gage readings / 5121/017 A-10
h. Annotate Sticker data from last filter install (CBR/HEPA filter gages) / 5121/017 A-10
i. Annotate “Red region starts” value. (CBR/HEPA filter gages)
j. Are installed lighting systems functioning properly?
4. CPS Alarms and Indicators / IAW / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U / S/U
a. Alarm Location and Zone
b. Alarm type?
c. Are there material problems / deficiencies with the Zone Sensor Box or Zone Pressure Alarm? / 5121/017 A-10
d. Is alarm operational?* / 5121/017 M-6
e. Are there material problems / deficiencies with the Alarm Master Panel or Slave Panel? / 5121/017 A-10
Are panels operational?* / 5121/017 M-6
f. Are there material problems / deficiencies with the Static Air Probe? (if applicable) / 5121/017 A-10
g. Are Zone sensor box condensate drain traps in proper working condition? / 5121/017 A-10
REMARKS:

ASSESSOR(S):______DATE: ______

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