Title Page

  • Banlaw-RGB.jpg
  • Document No.

  • Date/Time

  • BANLAW JOB INFORMATION

  • Prepared by

  • Document Number, Job Number and Description

  • CLIENT/SITE INFORMATION

  • Direct Site Contact for Appointment and Attendees

  • Location

  • Billing Types

  • Special Conditions

Scope of Work

  • Enter a new Job Task for each entry in Scope of Works

  • Task
  • undefined

Pre-work Checklist

  • Site Access and Training all up to date to perform the Job Tasks

  • Speak with site rep when entering property

  • Proper PPE for job, site and conditions

  • Tools in good condition to include computer

  • Parts Required

  • Part Requisition Form

  • Parts Requisition completed and Submitted

Conducting Work

  • Date of Work

  • Vehicle Inspection Complete

  • Complete Job Safety Paperwork(attach before work progresses)

  • Attach Safety Paperwork

  • Enter a new Line of information for each Job task in the Scope of Work

  • Line
  • Task Line

  • Description of work performed

  • Time: Hours (30 min increments)

  • Attach Pictures (Optional)

Defects / Action Items

  • For Each Defect/Action enter a new Action Item

  • Action
  • Replace Filters - 8 each - OFS-840X-3B - 5-Micron Beta>1000 filter element, 2 each - 12-000016 - O-Ring

  • Attach picture(Optional)

  • 1. Identify filter media replace filters (4) Oil Filtration filter elements, particulate removal (OFS-840X) 2. Identify and replace O-ring (1) O-Ring (12-000016) <br>3. Operations shall be locked out and tagged out prior to commencing work. (No<br>receiving or dispensing) try out by closing and isolating valves.<br>4. Remove cover from top and remove filter elements. 5. Install new filter elements . 6. Install covers, remove locks and test. 7. Write on filter or tag the filter change date. 8. Dispose of old filters.

  • comments

  • Attach picture(Optional)

  • Keyboard and Backlights operational (Xpress)

  • comments

  • Attach picture(Optional)

  • Panel seals, screws, and locks

  • comments

  • Attach pictures (Optional)

  • Display (Xpress)/Touchscreen (Advanced)

  • comments

  • Attach pictures (optional)

  • Keyboard and Backlights operational (Xpress)

  • comments

  • Attach pictures (Optional)

  • Digital inputs/Overfill protection/CPA/Level Switch

  • comments

  • attach picture (Optional)

  • Key fob reader

  • comments

  • Attach picture (Optional)

  • Communications to ResTrack server

  • comments

  • Attach picture (Optional)

  • Communications to TLM

  • comments

  • Attach picture (Optional)

  • Swipe Card Reader

  • comments

  • Attach picture (Optional)

  • FMS overrides

  • comments

  • Attach picture (Optional)

  • System UPS battery operational

  • comments

  • Attach picture (Optional)

  • Panel heater(s) operational

  • comments

  • Attach picture (Optional)

  • Secure-Fill dry-break swivel functionality and Auto-Id wire

  • comments

  • Attach picture (Optional)

  • Auxiliary Panel Indicators

  • comments

  • Attach picture (Optional)

  • SecureFill dry-break functionality and wiring condition

  • comments

  • Attach picture (Optional)

  • Secure-Fill splash fill functionality

  • comments

  • Attach picture (Optional)

  • Nozzle Holster(s)

  • comments

  • Attach pictures (Optional)

  • Loading arm/hose arrangement

  • comments

  • Attach pictures (Optional)

  • Breakaway valve / breakout point. *Specifically Only use Banlaw engineered studs in breakaway valves

  • comments

  • Attach pictures (Optional)

  • Unloading flow meter, Unloading RTD temperature probe and wiring, Unloading Flow computer for temperature compensation

  • comments

  • Attach pictures (Optional)

  • Dispensing flow meter, Dispensing RTD temperature probe and wiring, Dispensing Flow computer for temperature compensation

  • comments

  • Attach pictures (Optional)

  • Control Actuated ball valve(s)/solenoid valve(s) and pump control, Pressure relief on control valves and one-way valves back to tank

  • comments

  • Attach pictures (Optional)

  • Panel internal terminations are tight, Electrical conduits tight and sealed, Sensor cables, Panel earthing tight, Field terminations and junction boxes sealed tight

  • comments

  • Attach pictures (Optional)

  • Accurate Electrical Drawing(s)

  • comments

  • Attach pictures (Optional)

  • Remote fixed screen enclosure VGA, USB, Power Cable(do not unplug with the power turned on), Communication Device looks functional (ethernet lights on ports/Maestro/Moxa)

  • comments

  • Attach pictures (Optional)

  • Tank level sensor(s), Tank level temperature transmitter

  • comments

  • Attach pictures (Optional)

  • Des-Case Breathers - Do they need replaced?(Bulb indicator what color is it? Record the change out Date)

  • comments

  • Attach pictures (Optional)

  • All Lights functioning properly?

  • comments

  • Attach pictures (Optional)

  • Check for spills / leaks at fuel facility

  • comments

  • Attach pictures (Optional)

  • Check Containment Area for leaks, standing water, fuel

  • comments

  • Attach pictures (Optional)

  • Check Piping route for leaks, missing insulation, other issues?

  • comments

  • Attach pictures (Optional)

  • Check with Area Technician for any other issues at the facility

  • comments

  • Attach pictures (Optional)

Job Completion

  • Job Number

  • Total Hours (This Sheet)

  • Are there any action/defect items still required to complete job?

  • BANLAW Representative

  • CLIENT Authorized Representative

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.