AGFAB/Melbourne Water - Hydrographic Monitoring Site Electrical Audits

Melbourne Water Work Permit Number:

• Client / Site

• Hansen Identification available:

  Select Yes No

  • Yes
  • No

• Melbourne Water Work Permit Number:

  Yes

  No

  N/A

• Hansen identification:

  Yes

  No

  N/A

• Hansen Number:

• Location
  Address

• Conducted on

  Date

• Prepared by

MELBOURNE WATER HYDROGRAPHIC SITES

Work Planning

• Has Work Permit been issued by Melbourne Water to allow access to the monitoring station ?

  Yes

  No

  N/A

• Has a SWMS been developed to identify the Sequence of Work Activities - Identify Hazards - Controls Required ?

  Yes

  No

  N/A

• Are there additional Hazards which have been identified on this site?

  Yes

  No

  N/A

• List New Hazards and Controls:<br>

  Yes

  No

  N/A

• Are all employees aware of the identified Hazards and Controls ?

  Yes

  No

  N/A

Site appearance

• Access to the cabinet unobstructed ?

  Yes

  No

  N/A

• Concrete surround does not present a trip hazard ?

  Yes

  No

  N/A

• Cabinet position does not obstruct pedestrian or vehicle movement ?

  Yes

  No

  N/A

Cabinet condition

• Vandal or other damage obvious ?

  Yes

  No

  N/A

• Graffiti on cabinet ?

  Yes

  No

  N/A

• Condition of the cabinet and surround is acceptable, eg paint, weeds, etc ?

  Yes

  No

  N/A

• Locking system on access door functional ?

  Yes

  No

  N/A

• Access door hinges operational ?

  Yes

  No

  N/A

Equipment Testing - Plug In Equipment ( Item 1)

• Power supply for ?

  Main power supply

  Aux power supply

• Type of electrical connection ?

  Select Flexible lead with plug Hard wired installation

  • Flexible lead with plug
  • Hard wired installation

• Voltage ?

  Select 415 volt 240 volt 32 volt 24 volt 12 volt

  • 415 volt
  • 240 volt
  • 32 volt
  • 24 volt
  • 12 volt

• Faulty components replaced ?

  Yes

  No

  N/A

• Equipment Tested - Tagged ?

  Yes

  No

  N/A

• Tag number:

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Plug In Equipment ( Item 2 )

• Power supply for ?

  Main power supply

  Aux power supply

• Type of electrical connection ?

  Select Flexible lead with plug Hard wired installation

  • Flexible lead with plug
  • Hard wired installation

• Voltage ?

  Select 415 volt 240 volt 32 volt 24 volt 12 volt

  • 415 volt
  • 240 volt
  • 32 volt
  • 24 volt
  • 12 volt

• Faulty components replaced ?

  Yes

  No

  N/A

• Equipment Tested - Tagged ?

  Yes

  No

  N/A

• Tag number:

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Plug In Equipment ( Item 3 )

• Power supply for ?

  Main power supply

  Aux power supply

• Type of electrical connection ?

  Select Flexible lead with plug Hard wired installation

  • Flexible lead with plug
  • Hard wired installation

• Voltage ?

  Select 415 volt 240 volt 32 volt 24 volt 12 volt

  • 415 volt
  • 240 volt
  • 32 volt
  • 24 volt
  • 12 volt

• Faulty components replaced ?

  Yes

  No

  N/A

• Equipment Tested - Tagged and Recorded ?

  Yes

  No

  N/A

• Tag number:

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Plug In Equipment ( Item 4 )

• Power supply for ?

  Main power supply

  Aux power supply

• Type of electrical connection ?

  Select Flexible lead with plug Hard wired installation

  • Flexible lead with plug
  • Hard wired installation

• Voltage ?

  Select 415 volt 240 volt 32 volt 24 volt 12 volt

  • 415 volt
  • 240 volt
  • 32 volt
  • 24 volt
  • 12 volt

• Faulty components replaced ?

  Yes

  No

  N/A

• Equipment Tested - Tagged Recorded ?

  Yes

  No

  N/A

• Tag Number:

• Photo Taken ?

  Yes

  No

  N/A

Equipment Testing - Plug In Equipment ( Item 5 )

• Power supply for ?

  Main power supply

  Aux power supply

• Type of electrical connection ?

  Flexible lead with plug

  Hard wired installation

• Voltage ?

  415 volt

  240 volt

  32 volt

  24 volt

  12 volt

• Faulty components replaced ?

  Yes

  No

• Equipment Tested - Tagged and Recorded ?

  Yes

  No

  N/A

• Tag Number:

• Photo Taken ?

  Yes

  No

  N/A

Equipment Testing - Circuit Breakers ( Item 1)

• Component description ?

  Yes

  No

  N/A

• Trip out function tested ?

  Pass

  Fail

• Faulty components replaced ?

  Yes

  No

  N/A

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Circuit Breakers ( Item 2 )

• Component description ?

  Select Circuit Breaker RCD Device

  • Circuit Breaker
  • RCD Device

• Trip out function tested ?

  Pass

  Fail

• Faulty components replaced ?

  Yes

  No

  N/A

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Circuit Breakers ( Item 3 )

• Component description ?

  Select Circuit Breaker RCD Device

  • Circuit Breaker
  • RCD Device

• Trip out function tested ?

  Pass

  Fail

• Faulty components replaced ?

  Yes

  No

  N/A

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Circuit Breakers ( Item 4 )

• Component description ?

  Select Circuit Breaker RCD Device

  • Circuit Breaker
  • RCD Device

• Trip out function tested ?

  Pass

  Fail

• Faulty components replaced ?

  Yes

  No

  N/A

• Photo taken ?

  Yes

  No

  N/A

Equipment Testing - Circuit Breakers ( Item 5 )

• Component Description:

  Circuit Breaker

  RCD Device

• Trip out function tested ?

  Pass

  Fail

• Faulty Components Replaced ?

  Yes

  No

  N/A

• Photo Taken ?

  Yes

  No

  N/A

Additional site sketch if required to assist with the identification of potential hazards or opportunity for improvement.

• Add drawing

  Drawing

• Signature of the person conduction the Site Assessment.

  Sign

NOTE* This form has been developed as a reference only document to provide comprehensive site status reporting to Melbourne Water and does not form part of the AGFAB Management System document control system at this time.