Da Form 5457 PDF Details

Ensuring the safety and quality of drinking water in various operational contexts is paramount, a responsibility meticulously outlined in the DA Form 5457, also known as the Potable Water Container Inspection Report. This document, mandated by TB MED 577 and spearheaded by the Office of The Surgeon General, serves as a comprehensive checklist covering every aspect of potable water containers’ integrity and safety. This includes an in-depth review of container exteriors to ensure proper labeling and condition, the functionality and cleanliness of manhole covers, dispensing spigots, and valve assemblies, along with the interior conditions of the containers, whether they are made of stainless steel, aluminum, fiberglass, or fabric. Further details extend to the inspection of water tank trucks and the site conditions of container locations in field use, emphasizing the importance of operational readiness and health protection. Inspectors also assess water conditions, verifying chlorine levels and water sources, with a section dedicated to additional comments and recommendations. The inclusion of printed or typed inspector names alongside signatures completes the form, ensuring accountability and a high standard of potable water hygiene and safety for all personnel involved.

QuestionAnswer
Form NameDa Form 5457
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesarmy water buffalo inspection, water buffalo inspection form, 01ES, 2005

Form Preview Example

 

 

POTABLE WATER CONTAINER INSPECTION

 

REPORT DATE

 

For use of this form see TB MED 577; the proponent of this form is the Office of The Surgeon General.

 

 

 

 

 

 

 

 

 

TO

 

 

FROM

 

 

 

 

 

 

 

 

 

INSPECTION RATING

 

SERIAL NUMBER

MAP COORDINATE LOCATION

 

 

 

 

 

 

OWNING UNIT

 

MAINTENANCE NCO

UNIT REPRESENTATIVE

 

 

 

 

 

 

INSPECTION UNIT

 

DATE/TIME GROUP

INSPECTED BY

 

 

 

 

 

 

 

SECTION I. WATER TRAILER INSPECTION CRITERIA

YES

NO

1.

CONTAINER EXTERIOR

a.

Marked "POTABLE WATER ONLY"

 

 

 

 

 

 

 

b.

Clean/Good Repair

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

MANHOLE COVERS

a.

Rubber Gasket Intact

 

 

 

 

 

 

 

 

 

b.

Locking Mechanism Functions

 

 

 

 

 

 

 

 

c.

No Rust/Insulation Intact

 

 

 

 

 

 

 

 

d. Pressure Relief Valve Operates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

DISPENSING SPIGOTS

All Spigots Function

 

 

 

 

 

 

 

b. "T" Handle Operates Easily

 

 

 

 

 

 

 

 

c.

Protective Box Intact

 

 

 

 

 

 

 

 

d.

Locking Devices Function

 

 

 

 

 

 

4.

 

a.

 

 

 

 

DRAIN

Plug Installed Hand-Tight

 

 

 

 

 

 

 

 

 

b. Cracks Do Not Expose Fiberglass

 

 

 

 

 

 

 

 

c.

Plug/Hole Threads Undamaged

 

 

 

 

 

 

 

 

d.

Threads Not Rusted

 

 

 

 

 

 

5.

CONTAINER INTERIOR:

a.

 

 

 

 

 

Clean/Good Repair

 

 

 

 

 

 

STAINLESS STEEL AND

b.

 

 

 

 

 

 

 

 

 

No Rust

 

 

 

 

 

 

ALUMINUM

 

 

 

 

 

 

c.

Not Painted/Coated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

No Cracks/Dents Exposing

 

6.

CONTAINER INTERIOR:

a.

Polyurethane

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clean/Good Repair

 

 

 

 

 

 

 

FIBERGLASS

b.

Cracks/Chips Less Than 10%

 

 

 

 

 

 

 

 

c.

Fiberglass Exposed

 

 

 

 

 

 

 

 

d. Paint Surface Not Flaking

 

 

 

 

 

 

SECTION II. WATER TANK TRUCK INSPECTION CRITERIA

1.

CONTAINER EXTERIOR

a.

Marked "POTABLE WATER ONLY"

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

Clean/Good Repair

 

 

 

 

 

 

2.MANHOLE COVERS AND FILLING PORTS

3.DISPENSING VALVES

4.TANK INTERIOR

a.Rubber Gaskets Intact

b.Locking Mechanisms Function

c.No Rust/Insulation Intact

a.Valves Operate Easily

b.Hose Coupling Threads Undamaged

c.Dust Caps Attached to Valve Ports

a.Clean/Good Repair

b.No Rust

c.Steel/Aluminum Not Painted

DA FORM 5457, NOV 2005

APD LC v1.01ES

SECTION III. FABRIC TANK/DRUM INSPECTION CRITERIA

 

 

 

 

 

 

 

 

YES

NO

 

1.

CONTAINER EXTERIOR

a. Marked "POTABLE WATER ONLY"

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

Clean/Good Repair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

VALVE ASSEMBLY

c.

Plugs/Patches Secure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

Check-Valve Adapter Undamaged

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Coupler Valve Operates Easily

 

 

 

 

 

 

 

 

 

 

c. Dust Cap Attached to Coupler

 

 

 

 

 

 

 

 

 

SECTION IV. CONTAINER LOCATION (FIELD USE) INSPECTION CRITERIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

SITE CONDITIONS

a. Manholes/Parts Closed

 

 

 

 

 

 

 

 

 

 

b. Soakage Pits Constructed Beneath

 

 

 

 

 

 

 

 

 

 

 

Spigots

 

 

 

 

 

 

 

 

2.

WATER CONDITIONS

a. Chlorine Residual Adequate (

 

ppm)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Procured From:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENTS AND RECOMMENDATIONS:

 

 

 

 

 

 

 

 

 

 

 

 

PRINTED/TYPED NAME AND GRADE OF PVNTMED INSPECTOR: SIGNATURE:

REVERSE OF DA FORM 5457, NOV 2005

APD LC v1.01ES

2

How to Edit Da Form 5457 Online for Free

PVNTMED can be filled out without difficulty. Simply use FormsPal PDF tool to accomplish the job promptly. FormsPal development team is constantly working to expand the editor and help it become much faster for users with its handy features. Make the most of today's revolutionary opportunities, and discover a heap of unique experiences! To get started on your journey, go through these simple steps:

Step 1: Open the PDF file in our tool by hitting the "Get Form Button" in the top part of this webpage.

Step 2: The tool will give you the opportunity to modify most PDF documents in a variety of ways. Modify it with your own text, adjust existing content, and add a signature - all manageable in minutes!

This PDF form will involve some specific details; to guarantee accuracy, take the time to take into account the following guidelines:

1. Start completing the PVNTMED with a group of essential blanks. Note all the necessary information and be sure there is nothing missed!

water buffalo certification writing process shown (portion 1)

2. Once your current task is complete, take the next step – fill out all of these fields - DISPENSING SPIGOTS, DRAIN, CONTAINER INTERIOR STAINLESS STEEL, CONTAINER INTERIOR FIBERGLASS, a b c d, a b c d, a b c d, a b c d, All Spigots Function T Handle, Plug Installed HandTight Cracks Do, CleanGood Repair No Rust Not, CleanGood Repair CracksChips Less, SECTION II WATER TANK TRUCK, CONTAINER EXTERIOR, and MANHOLE COVERS AND FILLING PORTS with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

water buffalo certification conclusion process explained (step 2)

As for a b c d and CONTAINER INTERIOR FIBERGLASS, be certain that you take a second look in this section. The two of these are thought to be the most important fields in this page.

3. This step is generally easy - fill out all the empty fields in DISPENSING VALVES, TANK INTERIOR, a b c, a b c, Valves Operate Easily Hose, CleanGood Repair No Rust, DA FORM NOV, and APD LC vES in order to complete this part.

water buffalo certification completion process clarified (step 3)

4. This specific part comes next with the next few empty form fields to fill out: YES, CONTAINER EXTERIOR, VALVE ASSEMBLY, a b c, a b c, Marked POTABLE WATER ONLY, CheckValve Adapter Undamaged, SECTION IV CONTAINER LOCATION, SITE CONDITIONS, a b, ManholesParts Closed Soakage Pits, WATER CONDITIONS, a b, Chlorine Residual Adequate, and ppm.

a b c, CheckValve Adapter Undamaged, and SECTION IV CONTAINER LOCATION inside water buffalo certification

5. The pdf needs to be finalized by filling in this area. Here you will find a comprehensive set of blank fields that must be filled out with specific details to allow your document submission to be faultless: PRINTEDTYPED NAME AND GRADE OF, SIGNATURE, REVERSE OF DA FORM NOV, and APD LC vES.

Stage # 5 of submitting water buffalo certification

Step 3: Immediately after taking one more look at your fields and details, click "Done" and you're done and dusted! Right after registering afree trial account with us, it will be possible to download PVNTMED or email it right off. The PDF will also be readily accessible via your personal account page with all your modifications. FormsPal guarantees your information privacy by having a secure system that in no way saves or distributes any sort of private information used in the file. Rest assured knowing your paperwork are kept safe any time you work with our service!