Autoclave Annual Maintenance Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date
• Location
  Address

• Personnel

Customer Information

• Customer Name

• Site Location

• Department

Working hours

• Departure from home / hotel

  Date

• Arrival on site

  Date

• Departure from site

  Date

• Arrival home / hotel

  Date

• Any expenses(hotel,parking,tolls,congestion charge)

  Yes

  No

  N/A

• Departure from home / hotel

  Date

• Arrival on site

  Date

• Departure from site

  Date

• Arrival home / hotel

  Date

• Any expenses(hotel,parking,tolls,congestion charge)

  Yes

  No

  N/A

• Departure from home / hotel

  Date

• Arrival on site

  Date

• Departure from site

  Date

• Arrival home / hotel

  Date

• Any expenses(hotel,parking,tolls,congestion charge)

  Yes

  No

  N/A

• Departure from home / hotel

  Date

• Arrival on site

  Date

• Departure from site

  Date

• Arrival home / hotel

  Date

• Any expenses(hotel,parking,tolls,congestion charge)

  Yes

  No

  N/A

• Departure from home / hotel

  Date

• Arrival on site

  Date

• Departure from site

  Date

• Arrival home / hotel

  Date

• Any expenses(hotel,parking,tolls,congestion charge)

  Yes

  No

  N/A

Equipment Information

• Machine Make and model

• Machine Serial Number

• Machine Asset number

• Photo of outside of machine

  Media

Visit Detail

• Commercial detail

  Chargeable visit

  non chargeable visit

Description of Work to be Done

• Type of visit

  Select 1st Quarterly 2nd Quarterly 3rd Quarterly Annual Bi-Annual Insurance Inspection

  • 1st Quarterly
  • 2nd Quarterly
  • 3rd Quarterly
  • Annual
  • Bi-Annual
  • Insurance Inspection

Tick if applicable

• Check Pipe connections (air, water, steam)

• Check Door seal

• Door Safety edge

• Check Emergency stop button

• Check steam traps

• Check Solenoid valves

• Check Door safety controls

• Check Electrical connection

• Check Filters Air and bio

• Check Pneumatic valves

• Check Tri-clover seals

• Check printer and chart recorder

• Check all strainers

• Trolleys and carriages

• Check displays

• Is machines functioning to customers expectations?

Any Steam Tests Conducted During Visit?

• Steam Condensate Test (Laboratory Sample Test - 2 litres per machine and 2 glass vial for endotoxin test )

• Steam Quality Test

• Steam Conductivity Test

Parts

• Any parts fitted

  Yes

  No

  N/A

• Are any parts required following your visit?

  Yes

  No

  N/A

Visit Summary

• Summary and any recommendations

• Any photos to support findings or recommendations

  Media

• Any drawings or sketches to support findings or recommendations

  Drawing

• Is a return visit required?

  Yes

  No

  N/A

• Is a quotation required for additional items/work?

  Yes

  No

  N/A

• Sychem Engineer

  Sign

• Customer Authorised Person

  Sign

Office Use Only

• Parts Total

• Total Travel Time (Hours)

• Total Labour (Hours)

• Call Out Fee

• First Hour Charge

• Subsequent Hour Charge

• Over Night Expenses

• Misc