AGFAB Engineering PNEUMATIC PLUG FOR FLOW ISOLATION DAILY INSPRCTION CHECKLIST (Rev 0)

• Conducted on

  Date

DETAILS

• Client / Site: Barwon Water - Black Rock WRP Inlet Works Upgrade 400 Black Rock Connewarre

• Inspection Area:

• Works Description:

• Document No. HSE-F-017 ITP No:

WORK DETAILS

• Type of plug that is being installed / fitted

• Diameter of pipe/ outlet to be isolated

INSPECTION CRITERIA

• Required holding pressure

• Actual pressure

• Is the plug & pipe connection maintaining the required pressures when tested<br>

  Yes

  No

• Is the pressure controlling device in current calibration

  Compliant

  Non-Compliant

  N/A

• Does the plug & connection show signs of any structural damages, breakages or loose fittings

  Yes

  No

  N/A

• Does the plug & pipe connection show signs of stress or distortion to integrity

  Yes

  No

  N/A

• If the plug is anchored or housed to another support connection point, are there any signs this connection is loose or poorly secured

  Yes

  No

  N/A

APPROVALS

• Other Comments

• Person Completing the Checklist

  Select Greg Grima John Toner Shane Dando David Howard Greg Oman Ian McCormick

  • Greg Grima
  • John Toner
  • Shane Dando
  • David Howard
  • Greg Oman
  • Ian McCormick

• Signature:

  Sign

• Agfab Approval By:

  Select Greg Grima John Toner Shane Dando David Howard Greg Oman Ian McCormick

  • Greg Grima
  • John Toner
  • Shane Dando
  • David Howard
  • Greg Oman
  • Ian McCormick

• Signature:

  Sign