6 026 1 cycle purge test log
#: FN 6.026.1 Rev. 0
Foreperson’s Cycle Purge Instruction Set
Project Site/Name:
| Project Site/Name: | Date:(DDMMMYYYY) |
|---|---|
| Project Number: | Purge Test #: |
| Building #: | Room #(s): |
| System Name: | Purge Medium: |
| System Description: | Medium Source Lot/Batch#: |
| Line# (s): | Medium Source Type: |
| Drawings, PID/Spool #(s): Spools/PID attached | Locations Purged / Valve Tag #’s / Quantity: □Yes □No |
| Clean Wiper Test Required? | □Yes □No |
| Owner, GC, Trades, Others notified of plan? | □Yes □No |
| Pressure Test Verification Prior to Cycle Purge? Foreperson’s Initials & Date | // (foreperson) (DDMMMYYYY) |
Purging Report
Are all POU valves correctly labeled?
| Are all POU valves correctly labeled? | □Yes □No |
|---|---|
| Was each valve opened min 5 seconds per cycle? | □Yes □No |
| Was each valve purged a minimum of 3 cycles? | □Yes □No |
| Clean wiper test performed & passed? | □Yes □No □N/A |
| Non-conformance with labeling or particulate? | □Yes □No |
| If non-conformance, note details here: | |
| Purge Team Leader Print Name: | //(signature)(DDMMMYYYY) |
Foreperson’s Acceptance
| Print Name: | / |
|---|---|
| (signature) (DDMMYYYY) |