Conditional Survey

• Site conducted

• Conducted on

  Date

• Prepared by

• Building
  Address
• Location/Floor
  Address

Asset Details

• Asset Category

  Select HVAC Electrical Plumbing ELV Specialist Civil Others

  • HVAC
  • Electrical
  • Plumbing
  • ELV
  • Specialist
  • Civil
  • Others

• Asset name/no

• Is this Asset is located as per the design ?

  Yes

  No

  N/A

• Check the Overall condition of the Asset

  Excellent

  Good

  Satisfactory

  Poor

• Is the Asset having visible damages , wear & tear ?

  Yes

  No

  NA

• Is the Asset found having any abnormality during inspection

  Yes

  No

  NA

• Is the Asset is in Operation?

  Yes

  No

  N/A

• How long this Asset was in use ?

• Is this Asset Exceeded it’s life Cycle ?

  Yes

  No

  NA

• Is the Asset tag is installed and it’s in the asset list ?

  Yes

  No

  N/A

• Please attach the Asset tag picture

  Media

• Is the Asset is free from Hazard

  Yes

  No

  N/A

• Is regular maintenance/ppm has been carried out for this asset

  Yes

  No

  N/A

• Why PPM Not carried out ?

  Select Not required Under breakdown Not in use

  • Not required
  • Under breakdown
  • Not in use

• Last maintenance completed date

  Date

• Overall Condition of the Asset location (temp, cleanliness, wall, ceiling paints ,Supports)

  Good

  Fair

  Poor

  N/A

• General snags found during inspection if any

  Media

• Attach the picture of the Asset for documentation

  Media

conducted by

• Completed by

  Sign