FORM # J-019 (4/19) SHT 1 of 3

EQUIPMENT TYPE: USER REFERENCE:

EQUIPMENT TAG NO.: DESCRIPTION:
BI/JO NO.: PLANT NO. / LOCATION:
MODEL NO.: SERIAL NO.:
COMMISSIONING DATE:

SENSOR TYPE: SENSOR RANGE :

MONITOR TYPE: MONITOR RANGE:
LOW ALARM SET POINT: LOW ALARM RELAY CONTACT
HIGH ALARM SET POINT: HIGH ALARM RELAY CONTACT:
BYPASS INDICATION: EQUIPMENT FAULT ALARM:
SENSOR OUTPUT GAS COMPOSITION:

· APPLY A KNOWN CONCENTRATION OF H2S TO THE SENSOR AND CHECK READING AT

THE FRONT PANEL OF THE MONITOR

INPUT (% LEL) READING (% LEL)

· PERFORM THE FOLLOWING CHECKS TO THE SYSTEM:

CHECKS TO BE PERFORMED RESULT

PASS FAIL
IN A MULTI CHANNEL DESIGN, EVERY
SENSOR HAS ITS CONTROLLER

THE DETECTION SYSTEM IS FAIL SAFE

TABLE CONTINUES ON PAGE NO. 2

NOTE: This non-mandatory form may be used as the starting point to

assemble a pre-commissioning checklist. Entries should be revised,
added and deleted and approvals adjusted to reflect the needs of the
Project Acceptance Committee.
APPROVALS SAPMT INSPECTION OTHER DEPT. OPERATIONS
Signature & Date
 FORM # J-019 (4/19) SHT 2 of 3

EQUIPMENT TYPE: USER REFERENCE:

EQUIPMENT TAG NO.: DESCRIPTION:
BI/JO NO.: PLANT NO. / LOCATION:
MODEL NO.: SERIAL NO.:
COMMISSIONING DATE:

CHECKS TO BE PERFORMED RESULT

PASS FAIL
SENSOR IS INSTALLED ON A VIBRATION
FREE SURFACE

POWER IS 120 V AC, 60 HZ FROM UPS. ELSE,

POWER IS FROM A RELIABLE 120 V AC
SOURCE AND A BACKUP BATTERY IS
AVAILABLE.

SENSOR IS INSTALLED CLOSE TO THE

GROUND

20 % CAPACITY IS AVAILABLE IN THE

CONTROL RACK

HOUSING IS EXPLOSION PROOF

IN MANNED FACILITY, A HORN AND A BLUE

BEACON IS LOCATED AT EACH SENSOR
AND ACTUATED ONLY BY THAT SENSOR AT
HIGH ALARM.

IN MANNED FACILITY, THE ALARM CAN BE

ACKNOWLEDGED IN THE CONTROL ROOM
ONLY.

TABLE CONTINUES ON PAGE NO. 3

NOTE: This non-mandatory form may be used as the starting point to

assemble a pre-commissioning checklist. Entries should be revised,
added and deleted and approvals adjusted to reflect the needs of the
Project Acceptance Committee.
APPROVALS SAPMT INSPECTION OTHER DEPT. OPERATIONS
Signature & Date
 FORM # J-019 (4/19) SHT 3 of 3

EQUIPMENT TYPE: USER REFERENCE:

EQUIPMENT TAG NO.: DESCRIPTION:
BI/JO NO.: PLANT NO. / LOCATION:
MODEL NO.: SERIAL NO.:
COMMISSIONING DATE:

CHECKS TO BE PERFORMED RESULT

PASS FAIL
IN UNMANNED FACILITY, ALARM AND
BEACON ARE LOCATED AT EACH SENSOR
AND ACTUATED BY ANY CONTROL UNIT AT
LOW OR HIGH ALARM

IN UNMANNED FACILITY, A FLASHING

BEACONS IS INSTALLED AT THE GATE.

IN UNMANNED FACILITY, THE ALARM CAN

BE ACKNOWLEDGED AT EITHER THE
CONTROL ROOM OR AT THE SENSOR..

FOR THE TEST EQUIPMENT USED, PLEASE ENTER THE FOLLOWING:

EQUIPMENT NAME:

MANUFACTURER: DATE CALIBRATED:

REMARKS:

NOTE: This non-mandatory form may be used as the starting point to

assemble a pre-commissioning checklist. Entries should be revised,
added and deleted and approvals adjusted to reflect the needs of the
Project Acceptance Committee.
APPROVALS SAPMT INSPECTION OTHER DEPT. OPERATIONS
Signature & Date