Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
Report Form
Asset Area
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Wastewater
- Not Applicable
- Preliminary Treatment
- Odour Control
- Primary Treatment
- Secondary Treatment
- Effluent Disposal
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Dams
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Groundwater
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Trunk Mains
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Discipline
Asset Details
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Location / Site
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Equipment
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Functional Location Number
Deficiency Details
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Problem with the equipment
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Hazard Report Number
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Initiator
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Date
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Photo 1
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Photo 2
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Photo 3
Evaluate Operational Impact and Risk
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Consequences of deferring action, risk associated with operating in its current defective condition - use Water Corporation risk matrix
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Current Risk
Options
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What investigations have taken place to date - cost, replacement availability, asset criticality? What is the current situation?
Recommendations
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What is the preferred corrective action? Advantage of replacement / modification?
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PM Order Number
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Estimated date fix required
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Estimated cost
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Reviewed by
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Date
ADR Entered into ACA
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Entered by
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Date
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Comments