Date of Survey

Name of Surveyor

Site Address

Petrol Company

Site Contact / Phone number

Type of new equipment to be installed

Give manufacturer of existing equipment

Survey information

Will special equipment be required to remove existing machine etc, if yes state type of equipment, if fork lift truck, crane, skates and jacks etc, and duration of hire

Services give size and position from the entrance end of the wash bay
Is there an air supply to the wash bay
Type of air compressor or supply
Where is the air compressor situated
Water pump type and position
Water tank size and where is it situated


Has the wash bay got doors

Are the doors electrically operated

Are the doors interfaced with existing machine

Can the doors be interfaced with the new machine

Manufacturer of doors
Wash bay dimensions
Bay length
Bay width
Bay height
Entrance door width
Entrance door height
Exit door width
Exit door height
Condition of wash pad, if tracks air to be welded a hot works permit may be required
Work required to install an under chassis wash
Position and type of drainage in wash bay
Position and type of lights in wash bay
Give details of any plinths or ducts, and any additional building works required

Machine control

Give position of new Codax pedestal
Give position of new euro terminal
Give position of PV panel

Give location of stop

Are side screens / splash screens required
Are other safety devises IE narrow bay
State which devises are required
Electric supply to wash bay
Electrical supply to site size and location
Work required to update electrical supply

Re-use options

Reuse equipment
Summary of survey
Summary and additional information
Actions required, responsibility and completion date
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.