Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Foundation

  • Foundation: Cracked walls issues? If 'Yes' then enter description below with photo(s).

  • If Yes enter: Code=code/safety violation, 1=nearly failed/failed replace yr1, 2=nearly failed, replace yr2 or yr3, 3=good/fair condition (50% remaining life), 4=very good condition (>75% remaining life), 5=new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Foundation: Settlement issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Foundation: Deterioration issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Foundation: Drainage issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Basement Construction

  • Floor Slab issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Wall Condition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Wall Settlement issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Water Intrusion issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Superstructure

  • Floor Structure issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Roof Structure issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Exterior Enclosure

  • Exterior Wall Condition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Wall Caulking issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Wall Cleaning & Pointing issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Wall Painting issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Wall Window issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Door condition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Hardware issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Roofing

  • Roofing issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Parapet issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Flashing issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Drainage issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Interior Construction

  • Ceiling issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Interior Wall/Partition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Interior Door issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Interior Hardware issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Stairs

  • Stair Construction issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Stair Finish issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Stair Handrail issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Conveying Systems

  • Elevator Condition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Escalator Condition issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Plumbing System

  • Plumbing Fixture issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Domestic Water Distribution issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Back Flow Preventer issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Sanitary Waste System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Storm Water Drainage issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Other Plumbing Systems issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

HVAC Systems

  • Fuel Energy Supply System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Heat Generation System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Heat Rejection/Cooling Tower System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • HVAC Distribution System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Terminal & Package Unit issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • HVAC Instrumentation & Controls issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • HVAC System TAB issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Other Special HVAC Systems/Equipment issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Fire Protection Systems

  • Sprinkler System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Standpipe issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Fire Pump issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Other Fire Protection System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Electrical Systems

  • Electrical System Capacity issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Electrical Service & Distribution issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Branch Wiring issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Lighting System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Special Electrical System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • EMS/Controls System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exit/Emergency Lighting system issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Other Electrical System issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

Site Conditions

  • Building Access issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Sidewalks & Steps issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Exterior Lighting issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Drainage issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

  • Utilities & Services issues? If 'Yes' then enter description below with photo(s)

  • If Yes then code as follows: Code=code/safety violation, 1=Item nearly failed/failed to be replaced in year 1, 2=Item has nearly failed to be replaced in year 2 or 3, 3=Item is in good to fair condition (50% remaining life), 4=Item is in very good condition (>75% remaining life), 5=Item is new or like new (>90% remaining life)

  • Enter funds year

  • Enter opinion of probable cost

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.