Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
General Information
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Belt Condition
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Splice Condition
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Wear Condition
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Belt Surface Temperature
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Belt Speed (rpm)
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Structure-Rails
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Structure-Floor
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Spillage-Front
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Spillage-Mid
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Spillage-Tail
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Equipment
Head
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Pulley Condition
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Belt Cleaners
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Belt Tracking Condition
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Plow Condition
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Head Noise (dB)
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Head Bearing 1 Vibration (Hz)
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Head Bearing 2 Vibration (Hz)
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Head Section Temperature
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Motor Temperature
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Gearbox Temperature
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Amperage Consumed
PT
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Gearbox Vibration (dB)
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Motor Temperature
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Hydraulic Hose Condition
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Snub Pulley Condition
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V-Belt Condition
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Sheaves Condition
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Motor Noise Level (dB)
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Gearbox Noise Level (dB)
Bend
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Pulley Condition
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Take-Up Bearing Condition
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Take-Up Condition
Middle
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Idler Condition
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Noise Level (dB)
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Skirt Condition
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Material Build-Up
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Return Idler Condition
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General Noise Level (dB)
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Conveyed Material Temperature
Tail
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Tail Pulley Condition
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Tail Noise Level (dB)
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Tail Section Temperature
Extra Points
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Grease Points Lubricated
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Noise
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Oil Levels
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Running Analysis
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Speed
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Temperature Readings
Travel Information
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Travel Time
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Round Trip Mileage
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Other
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Other
Action Request
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Total Labour
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Comments
