White – Vessel Canary – Service Station Pink – Factory 50-REV3002
NO:
1907
RECREATIONAL LIFERAFT RE-INSPECTION CERTIFICATE
This is to certify that this liferaft has been inspected and serviced in accordance with the
REVERE SURVIVAL PRODUCTS
servicing manuals.
MODEL: __________________________SIZE (circle one) 2 4 6 8 SERIAL NO: ____________________________
DOM: _____/_____/_____ DATE OF PREVIOUS INSP: ______/_____/______DATE OF NEXT INSP: _____/_____/______
OWNER NAME: ___________________________________VESSEL:______________________________________
ADDRESS: ________________________________CITY:___________________STATE:__________ZIP:__________
PHONE NO: _____/____/______EMAIL (optional) ________________________@__________________________
CO
2
CYLINDER
CO
2
Cyl SN:
Hydro Date:
CO
2
Wt:
N
2
:
Total:
CO
2
Cyl Recharged:
Hydrostatically tested:
PRV AIR PRESSURE TEST
Relief Valve Upper Tube
Open:
Closed:
Relief Valve Lower Tube
Open:
Closed:
AIR RETENTION TEST
Temp.
Barometer
Pressure
Temp.
Barometer
Pressure
Correction
Final
Upper Tube
On
Off
Lower Tube
On
Off
Floor
EQUIPMENT ITEMS
Item
Checked
Replaced
Item
Checked
Replaced
Instruction hand book
Survival manual
Bailer
Hand / Foot pump
Flashlight spare bulbs
Paddles
Sea-sickness bags
Plugs – Repair (kit)
Whistle
Rescue quoit w / line
Waterproof Flashlight
Log book
Canopy Battery Pack
Vacuum bag
Sponges
Container Bands
EXP. DATE
Heliograph / Signal mirror
Food Rations
Signal Card
Water Rations
Fishing kit
Flashlight batteries
Sea-Anchor
Cement
Tin opener
Anti Seasick Tablets
Floating Knife
First Aid Kit
Painter Assembly
Hand Flares
Instruction Handbook
Parachute flares
LABELS MISCELLANEOUS ITEMS REPAIR WORK / CONTAINER REPAIR
THIS SERVICE PERFORMED BY:
Service Station: _________________________________________________
Print Name: ______________________________________ Address: _______________________________________________________
Signature: ________________________________________ _______________________________________________________
Date of Inspection: __________/___________/__________ _______________________________________________________
Container label
Logo
Data Panel
Inflation instructions
Activate Painter
Liferaft launch instructions
Inspection label
7720 Philips Highway, Jacksonville, FL 32256
