Title Page

  • STW Location

  • Chemical Supplier

  • Date & Time

  • Chemical to be Delivered

  • Quantity

  • Strength

  • Prepared by

  • Address
    1. Please answer "Yes," "No," or "N/A" on the questions below.
    2. Add photos and notes by clicking on the paperclip icon
    3. To add a Corrective Action click on the paperclip icon then "Add Action," provide a description, assign to a member, set priority, and due date
    4. Complete audit by providing digital signature
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  • Driver has signed in and completed the site induction

  • Driver has contractor RAMS documents complete with centrally issued authorisation

  • Check delivery note confirms that it is the correct chemical being delivered and it meets the required BS:EN Standard and/or is Regulation 31 approved?


  • (Check current Barrel List on Waterpedia for correct BS:EN Number & Delivery Note for Reg 31 approval)

  • Record Barrel Number:

  • Check Barrel Number is listed on current Barrel List on Waterpedia If NO - reject delivery


  • Locate and check operation of wash down hoses

  • Check operation of emergency showers & eyewash, and location & contents of emergency spill kits

  • Confirm means of communication between driver & supervisor (usually mobile phone)

  • Confirm with driver that they must contact the STW delivery supervisor prior to disconnection

  • Driver must stay with and be in control of delivery at all times

  • Understand how STW staff can stop the delivery in an emergency if driver is incapacitated

  • Check correct chemical will be loaded into the correct tank, that there is sufficient full delivery and if IBC pump over check chemical labelling on IBC space in tank to accept

  • Tank Number:

  • Check all tank, bund and line valves are in correct position and check tank for signs of damage/leaks

  • Carry out a lamp test on the panel at the delivery point i.e. tank level and high level alarm

  • Check driver & STW operator have COSHH data info on site, immediately available and in date

  • Check Chem-e-safe containment of delivery drainage area. drains re-valved & all bunds empty

  • Check all personnel are outside exclusion area and warning signs erected 'Delivery in Progress'

  • Remove lock off from delivery point

  • Carry out visual check to ensure driver has correctly connected pipework i.e. for flange connections all 4 bolts are tight with a gasket in between the flanges. NB Driver is responsible for making the connection


  • STW Staff

  • Contact Person(s)

  • Telephone Number(s)

  • Chemical Delivery Company

  • Contact Person(s)

  • Telephone Number(s)


  • Sign below to confirm that delivery procedures have been explained, the above checks have been completed and discharge is authorised to begin:

  • STW Name & Signature

  • Driver's Name & Signature


  • Open delivery valve on STW side of connection point if applicable

  • STW Operator to withdraw outside exclusion zone

  • Inform the driver that he must carry out a gravity test before pressurizing the system

  • OBSERVE DELIVERY FOR 5 MINUTES. Check for obvious potential issues such as liquid in bunds, leaks from connections, gauges on tanks not showing an increase etc.

  • When contacted by driver return to delivery are to observe safe disconnection, fit blanking flange, lock delivery point and return valves to correct position. FULL PPE MUST BE WORN WHEN INSIDE EXCLUSION ZONE


  • Take photographs or scan in this sheet and all delivery paperwork(Delivery Note, Chemical Conformity Paperwork) and email to Area Planning Assistant, Send Paper Copies to Planning Assistant for filing

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