Meehan Appendix 1 53 (2)

Name of deceased:                                                                                                             Age:

Training and experience:

Time and Date of incident: (24hr : yyyy/mm/dd)

Location of incident:

Location of equipment:

Date of inspection of equipment:

Equipment inspected by other agencies:    Y                             N

If above Y, inspected by whom:

Equipment photographed by other agencies:           Y                             N

If above Y, photographed by whom:           

Equipment photographed by other agencies:           Y                             N

If above Y, photographed by whom:

Weather Conditions:

Wind Direction at time of incident (if known):

Air Inlet upwind / downwind of compressor unit:

Hookah location at time of incident:            Boat                           Flotation device                             Land

Surface type compressor was located on (if on land)

Clearance space around compressor (m):  

Hookah Brand:

Serial Number:

Description of complete system from air intake to diver(s) regulator(s):         

Condition:

Good

Fair

Poor

Notes/Observations

Air Intake Filter

Air Intake

Compressor

Linkage between motor and compressor (e.g., belt)

Compressor motor

Exhaust

Air Reserve Tank including volume

Supply Hose

Hose attachments to compressor

Regulator and attachment to diver

Harness/Vest

Weight belt or vest

Compressor Brand / Model No.

Compressor motor type:             Petrol              Diesel               Electric

Engine type:                                   2 STROKE / 4 STROKE

Fuel level:

Compressed gas output:              AIR                   NITROX

Stated output in litres per minute / cubic feet per minute (CFPM):

Stated line pressure (bar):

Presence of a governor:

Last documented service date:

Inspection / Maintenance Log available:                     Y                  N

Owner air test result available:                                      Y                  N

If Y, results:

Air delivery system:                    Diaphragm                                    Piston

Pressure relief valve:                  Functioning?           Y / N             Setting (bar):

Oil filter:                                                        Oil level:        

Lubricant type for internal parts (air side):

Condensation drain condition:                                                         Water present in drain:    Y / N         

Site of air hose connections relative to compressor:                                                                                                          

To reserve tank:                                             Direct connection to compressor:

Length of air intake (m):

Horizontal distance of intake from compressor (m):

Height of intake above compressor (m):

Air intake free of obstructing debris?      Y / N

Air intake free of damage?                         Y / N

Filter present at intake:                             Condition of filter:                             

Filter type:                                                    Date of last change (if known):

Connection type to compressor:              Bayonet?               Y / N

Condition of exhaust port:

 Distance from air inlet (m):

Storage Capacity (L):

Integrated into frame of compressor or separate stand-alone unit:

Construction material:    Stainless Steel  /  Aluminium  /  Other (please specify):

Water trap:     Y / N

Particle filter:  Y / N                                 Rated to (µm):

Location of particle filter: Between compressor and reserve tank         

                                                                                                                                                                                                                                                                                                 Between reserve tank and diver                                                                                                      

Type of particle filter:                      Macro particle / Carbon filter / Other (e.g. Hopcalite)

Air redundancy?              Yes, via surface cylinder                   Yes, with diver                   No             

No. of hoses:

No. of connections directly to compressor:

Hose brand:

Colour of hose:

Condition of hose:

Any visible damage / scuffs?

Can hose be kinked?

Length of hose (m):                                                           Internal Diameter of hose (mm):

Non return valve:                                     Present                         Absent

Hookah specific regulator:      Y / N

Modified SCUBA regulator:     Y / N

Brand / Model no:

Condition of regulator including mouthpiece and exhalation valves:

Cracking pressure of regulator:

Accessory air supply:                             Spare Air / Octopus + Cylinder / None

Air Test Kit Product:

Carbon Dioxide

Carbon Monoxide

Water Vapour

Oil in air

Odour

Oxygen concentration (%)

Tested volume output of the hookah apparatus (l/min)

Volume of reserve air tanks (l)

(A)   Maximum flow at hookah air outlet source

(B)   Maximum flow (l/min) at delivery point to regulator (1)
                 *must exceed or match manufacturer’s stated output

(C)   Maximum flow (l/min) at delivery point to regulator (2)
                *must exceed or match manufacturer’s stated output 

Does (B) + (C) equal measurement (A) or is output flow reduced?

Hose configuration:

Is there a “Y” or “T” configuration which creates more than one air supply hose from a single outlet at the hookah apparatus?

Driving pressure test:

Differential pressure readings between surface and end of air supply hose (psi)

0m:

5m:

10m:

15m:

Time to depletion of air supply in event of compressor failure or purge of second line.