Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Store Manager

  • Auditor

HVAC

AC System

  • Responsibility of HVAC

  • Central Air Conditioning plant installed?

  • AC System

  • Unit
  • Add media

  • Serving Area

  • Unit Manufacturer

  • Unit Model

  • Unit Serial

  • Unit Type

  • Unit Configuration

  • Cooling Capacity in Btu

  • Heating Capacity in Btu

  • Controller

  • Add media

  • Type

  • Model

  • Additional Information

  • Compressors

  • Compressors installed

  • Compressor
  • Add media

  • Manufacturer

  • Model

  • Serial

  • Type

  • Additional Information

  • Evaporator Fan & Motor

  • Fan & Motor

  • Unit
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  • Fan Manufacturer

  • Fan Model

  • Fan Serial

  • Motor Manufacturer

  • Motor Voltage

  • Motor Model

  • Motor Serial

  • Fan Wedge Belt size

  • Wedge Belt quantity

  • Additional Information

  • Condenser

  • Add media

  • Condenser Type

  • Add media

  • Manufacturer

  • Model

  • Serial

  • Fan Motor Manufacturer

  • Fan Motor Serial

  • Fan Wheel Manufacturer

  • Fan Wheel Model

  • Fan Wheel Serial

  • Wedge Belt Size

  • Wedge Belt Quantity

  • Bearings Size

  • Bearing Quantity

  • Pump Motor Manufacturer

  • Pump Motor Model

  • Pump Motor Serial

  • Pump Manufacturer

  • Pump Model

  • Pump Serial

  • Damper Motor Manufacturer

  • Damper Motor Model

  • Damper Motor Serial

  • Additional Information

  • Add media

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Type of Cooling Tower

  • Fan Motor Assembly

  • Assembly
  • Fan Assembly Manufacturer

  • Fan Assembly Model

  • Fan Assembly Serial

  • Fan Motor Manufacturer

  • Fan Motor Model

  • Fan Motor Serial

  • Fan Wheel Manufacturer

  • Fan Wheel Model

  • Fan Wheel Serial

  • Wedge Belt Size

  • Wedge Belt Quantity

  • Bearings Size

  • Bearing Quantity

  • Pump Motor Manufacturer

  • Pump Motor Model

  • Pump Motor Serial

  • Pump Manufacturer

  • Pump Model

  • Pump Serial

  • Damper Motor Manufacturer

  • Damper Motor Model

  • Damper Motor Serial

  • Additional Information

  • Air cooled condensers

  • Condenser
  • Add media

  • Manufacturer

  • Model

  • Serial

  • Fan Assembly Manufacturer

  • Fan Assembly Model

  • Quantity of Fan Assemblies per condenser

  • Additional Information

  • Comments

Plant operation and control

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  • System in service?

  • Plant control selection:

  • All temperature sensors in range?

  • Controller/ Control panel free from alarms?

  • All buttons, switches, indication lights and displayes in working condition?

  • Date and time settings correct on controller/ 7 day timer?

  • Scheduled ON/OFF program set on controller/ 7 day timer?<br>

  • FR cable connected to fire relay/ input?

  • Comments

Electrical enclosure and safeties

  • Add media

  • Glands used on all cable enteries?

  • Control and fan circuit fed from Emergency section?

  • Compressors & heaters fed from Normal section?

  • All circuit breakers in the ON position?

  • Conductors/cables free from signs of overheating and surface damage?

  • Terminals and connection free from signs of overheating and damage?

  • Protection and safety devices wired properly and have not been bypassed?

  • Phase/ sequence failure relays functional?

  • Safety and protection devices functional?<br>

  • Unit and components earthed?

  • Panel clean and dry?

  • All wiring neat and trunking covers in place?

  • Lights and plug points in working condition?

  • Comments

Ventilation and filtration

  • Add media

  • Condition of filter bank?

  • Filter Quantities and sizes

  • Wedge belts tensioned and in good condition?

  • Drive guards in place and secured?

  • Fan motor free from defects, abnormal noise or vibration?

  • Supply air fan free from defects, abnormal noise or vibration?

  • Emergency STOP switch installed and within reach from motor?

  • Economy damper motors installed and functional?

  • Comments

Heating

  • Type of heating?

  • Add media

  • Operational?

  • Comments

  • Add media

  • Operational

  • Heater elements free from surface rust and damage?

  • Terminal connections and cabling free from signs of overheating?

  • Comments

Refrigeration circuit

  • Add media

  • Refrigerant circuit

  • Circuit
  • Compressor

  • Compressor
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  • Compressor operational?

  • Oil level (%):

  • Suction Pressure (kPa):

  • Discharge Pressure (kPa):

  • Free from refrigerant and oil leaks?

  • Free from abnormal vibration and noise?

  • Compressor properly secured?

  • Unloaders functional?

  • Crankcase heater installed and functional?

  • Circuit free from pressure or temperature loss across liquid/ suction line driers?<br>

  • Liquid line solenoid valve operational and system pump down functional?

  • Expansion device functional, feeler bulb insulated and distributor lines free of frost?

  • Comments

Condensing unit

  • Type of condenser

  • Spray pump & motor assembly operational without defects or water leakages?

  • Fan motor and fan drum operational without any defects?

  • Wedge belts and pulleys in good condition

  • Damper motor functional?

  • Spray nozzles operational without blockages?

  • Refrigerant lines inside evaporative condenser still in good condition?

  • Water treatment system in place and functional?

  • Float valve functional and set correctly?

  • Sump clean and free from water leakages?

  • Comments

  • Condenser coils clean and in good condition?

  • Condensers free from refrigerant leaks?

  • Fan cycle switches set correctly?

  • All condenser fans operational?

  • Does the fans turn in the correct direction?

  • Comments

  • Spray pump & motor assembly operational without defects or water leakages?

  • Fan motor and fan drum operational without any defects?

  • Fan Assemblies operational without defects?

  • Wedge belts and pulleys in good condition?

  • Damper motor functional?

  • Spray nozzles operational without blockages?

  • Refrigerant lines inside evaporative condenser still in good condition?

  • Water treatment system in place and functional?

  • Float valve functional and set correctly?

  • Sump clean and free from water leakages?

  • Comments

General

  • Unit free from corrosion?

  • Does the chamber doors seal properly?

  • Are the unit well maintained?<br>

  • Condensate water draining freely from the unit?

  • All ducting and canvas still in good condition?

  • Fusible links installed on dampers?

  • Unit base standing on Teco pads?

  • Ducting in good clean condition?

  • Comments

Split air conditioners

  • Split Air Conditioners installed?

  • Split air conditioning units

  • Unit
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  • Area serving

  • Indoor unit

  • Type

  • Manufacturer

  • Model

  • Serial

  • Cooling Capacity in Btu

  • Heating Capacity in Btu

  • Outdoor unit

  • Manufacturer

  • Model

  • Serial

  • Refrigerant type

  • Additional Information

  • Unit operational?

  • Heating and cooling properly?

  • Unit free from refrigerant leaks?

  • Remote controller in working condition?

  • General condition?

  • Comments

Ventilation

  • Ventilation or Extraction fans installed? <br>(Exclude smoke extraction fans from this section)

  • Ventilation/ Extraction

  • Ventilation fan
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  • Area serving:

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Operational?

  • Free from corrosion and damage?

  • Louvres in good condition?

  • Comments

Fire detection and control

Fire Panel

  • Fire Panel installed?

  • Fire Panels installed

  • Panel
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  • Location Installed

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Panel free from alarms, disabled zones and faults?

  • Accurate date and time displayed on panel?

  • Panel in general good and clean condition?

  • Comments

Fire Extinguisher

  • Last service date

  • Fire extinguishers installed?

  • Add area installed( Trading floor , Receiving area , Office )

  • Area
  • Add media

  • Area :

  • Count Dry Powder

  • Count CO2

  • Comments :

Fire Hose Reels

  • Last service date

  • Fire Hose Reels installed?

  • Add area installed ( Trading floor , Receiving area , Office )

  • Fire Hose Reel
  • Add media

  • Area:

  • Count

  • Comments

Sprinkler System

  • Sprinkler system installed?

  • Sprinkler system owner

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  • Is the colour code of the piping red?

  • Piping in visual good condition?

  • Are sprinkler heads and piping free from leaks?

  • Are the piping free from corossion?

  • Does pressure gauges exist, are they free from damage and are they functional?

  • Comments

  • Add media

  • Is the colour code of the piping red?

  • Water tanks free from corrosion and leaks?

  • Are the tanks full?

  • Are sprinkler heads and piping free from leaks?

  • Are the piping free from corossion?

  • Does pressure gauges exist, are they free from damage and are they functional?

  • Diesel engine & pump installed?

  • Engine

  • Add media

  • Engine manufacturer:

  • Engine model:

  • Engine serial/number:

  • Rated kW output @ rpm:

  • Additional information:

  • Pump

  • Add media

  • Pump model:

  • Pump serial:

  • Additional information:

  • Battery

  • Manufacturer:

  • Model/ series:

  • Capacity:

  • Type:

  • Additional information:

  • Battery Charger

  • Add media

  • Manufacturer:

  • Model/ series

  • Rating:

  • Additional information

  • Is the control panel on and free from fault conditions?

  • Radiator cap in good condition?

  • Coolant level in order?

  • Coolant system free from leaks?

  • Radiator free from debris?

  • V-belts and radiator fan in good condition?

  • Pocket/ Jacket heater in working condition?

  • Heater hoses free from cracks?

  • Engine oil level in order?

  • Oil lines and components free from leaks?

  • Fuel level 80% or above?

  • Fuel lines free from leaks and cracks?

  • All covers and guards in place?

  • Battery terminals are tight and free from oxidation?

  • Sight glass on battery is green indicating sufficient charge?

  • Mechanical fuel shut off mechanism with fusible link installed?

  • Fire extinguisher install in or near the vicinity?

  • Engine placed on Teco pads?

  • Hinged metal flap installed on vertical outlet exhaust?

  • Bird guard installed on horizontal outlet exhaust?

  • Exhaust covered with lagging?

  • Engine in good clean condition?

  • Pump free from leaks?

  • Pump free from debris/ corossion?

  • Comments:

Smoke Extraction

  • Smoke relief panel installed?

  • Smoke relief panels installed

  • Smoke relief panel
  • Add media

  • Location installed

  • Power ON?

  • Panel in good and clean condition?

  • Control Mode

  • Comments

Smoke extractor fans

  • Smoke Extractor fans installed?

  • Smoke extractor fans

  • Fan
  • Add media

  • Location installed

  • Manufacturer

  • Model

  • Serial

  • Fire rating

  • Additional Information

  • Functional?

  • Burglar proofed?

  • Does the fans service as ventilation as well?

  • Comments

Smoke relief dampers

  • Smoke relief dampers installed?

  • Dampers in good condition?

  • Does the dampers close properly?

  • Dampers mechanism free from obstructions?

  • Trigger type

  • Air compressors

  • Compressor
  • Manufacturer:

  • Model:

  • Serial:

  • Tank size:

  • Capacity : ( CFM or liters/min)

  • Manufacture date:

  • Compressor operational?

  • Water separator installed?

  • Pressure switches operational?

  • Compressor free from air leaks?

  • Compressor and tank free from corrosion?

  • Is the compressor located in a suitable area and protected from outdoor elements?

  • Are all fusible links in place?

  • Damper motor in place and secured?

  • Damper connected to solenoid and spring in place?

Vertical Transport

Conveyors

  • Conveyor installed?

  • Add media

  • Location installed

  • Manufacturer

  • Model

  • Serial

  • Additional information

  • Control station functional and in good condition?

  • Emergency stop functional?

  • Conveyor belt in good condition?

  • Mechanics free from abnormal noise or vibration?

  • All covers and drive guards in place?

  • Comments

Dock Levellers

  • Dock Levellers installed?

  • Dock Levellers installed

  • Dock Levelers
  • Add media

  • Location installed

  • Type of dock leveller

  • Manufacturer

  • Model

  • Serial

  • Lifting capacity in kg

  • Motor & Pump assembly

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Oil level visible and on correct level?

  • Controls functional?

  • Emergency stop installed and functional?

  • Hoses and connections free from oil leaks?

  • Bottom safety switch functional?

  • Motor & pump operates without abnormal noise?

  • Pressure gauges functional?<br>

  • Swing lip functional?<br><br>

  • Extended lip functional?

  • Pit in clean and dry condition?

  • Comments

Scissor lifts

  • Scissor lifts on site?

  • Scissor lifts

  • Scissor lift
  • Manufacturer

  • Model

  • Serial

  • Type

  • Additional Information

  • Control panel clearly marked and operational?

  • Emergency stop functional?

  • Emergency lowering device functional?

  • Guardrails, mid-rails, chain or bar appropriately in place?

  • Tyres/wheels in good condition?

  • Hydraulic hoses damage free and without signs of leakage?

  • Free from corrosion?

  • Comments

Passenger lifts

  • Passenger Lift installed?

  • Passenger Lifts

  • Passenger lift
  • Add media

  • Location installed?

  • Manufacturer

  • Model

  • Serial

  • Lift number

  • Load Capacity

  • Additional Information

  • Call stations functional?

  • Doors open and close properly?

  • Door switch functional?

  • Lift stop at the correct level?

  • Alarm button installed inside lift?

  • Emergency stop functional?

  • Sufficient lighting?

  • Comments

Hoists

  • Hoist installed?

  • Comments.

Escalators

  • Escalator installed?

  • Add media

  • Location installed

  • Manufacturer

  • Model

  • Serial

  • Additional information

  • Is the escalator operational?

  • Steps and handrails in good condition?

  • Smooth operation without any abnormal noise of vibration?

  • Emergency stop switches functional?

  • Comments

Goods lifts

  • Goods Lift installed?

  • Goods Lifts

  • Lift
  • Add media

  • Location installed?

  • Manufacturer

  • Model

  • Serial

  • Lift number

  • Load Capacity

  • Additional Information

  • Call stations functional?

  • Doors open and close properly?

  • Door switch functional?

  • Lift stop at the correct level?

  • Alarm button installed inside lift?

  • Emergency stop functional?

  • Sufficient lighting?

  • Comments

Generator

Standby generator

  • Responsibility of Generator

  • Generators installed

  • Generator
  • Add media

  • Type of installation

  • Comments

Alternator Specifications

  • Add media

  • Manufacturer

  • Model

  • Serial

  • Type

  • kVA rating

  • Additional Information

  • Comments

Engine Specifications

  • Add media

  • Manufacturer

  • Model

  • Serial / Engine number

  • Output kW @ rpm

  • Additional Information

  • Comments

Controller

  • Add media

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Comments

Circuit Breakers & Change Over

  • Add media

  • Mains Breaker Details

  • Alternator Output Breaker Details

  • Generator Breaker Details

  • Change-Over Type

  • Mains Contactor

  • Manufacturer

  • Model

  • Rating

  • Coil voltage

  • Additional Information

  • Generator Contactor

  • Manufacturer

  • Model

  • Rating

  • Coil voltage

  • Additional Information

  • Manufacturer

  • Model

  • Rating

  • Additional Information

  • Comments

Battery Information

  • Add media

  • Battery Charger

  • Manufacturer

  • Model

  • Serial

  • Rating

  • Starter Batteries

  • System Voltage

  • Manufacturer

  • Model / Series

  • Capacity

  • Type

  • Installation date

  • Additional Information

  • Comments

Fuel Tank

  • Add media

  • Fuel Tank Dimensions

  • Approximate volume

  • Additional Information

  • Comments

General Checks

  • Radiator cap in good condition?

  • Coolant level in order?

  • Cooling system free from leaks?

  • Radiator & Intercooler free from debris?<br>

  • Pocket/ Jacket heater in working condition?<br>

  • Heater hoses free from cracks?

  • Engine oil level in order?

  • Oil lines and components free from leaks?

  • Fuel level on 80% or above?

  • Fuel lines free from leaks and cracks?<br>

  • Engine in good, clean condition?<br>

  • Alternator heaters in working condition?

  • Alternator in good, clean condition?

  • Battery terminals are tight and free from oxidation?

  • Sight glass on batteries are green indicating sufficient charge?

  • Mechanical fuel shut off mechanism with fusible link installed?

  • Fire extinguisher installed in or near the vicinity?

  • Genset base placed on Teco pads?<br><br>

  • Hinged metal flap installed on vertical outlet exhaust pipe?

  • Bird guard installed on horizontal outlet exhaust pipe?

  • Exhaust covered with lagging?

  • Good housekeeping being maintained?

  • Additional Information

  • Comments

Control/ Electrical Panel

  • Controller/ control panel functional without alarms or trips active?

  • Generator in "Auto Mode"?

  • Record run hours (Indicate ODO / and controller hours)

  • Panel indication lights working (test using "lamp test" buttom - if fitted)?

  • Voltage / Amp selector switches and meters working or visible on controller display?<br>(Some readings will only be visible when generator is running)

  • Battery charger operational without alarms/ abnormal noise?

  • Emergency stop switch fitted on panel or near generator?<br>(indicate whether a strobe/siren is also fitted)

  • Panel in good, clean and neat condition?

  • Electrical components and cables free from signs of overheating and arcing?

  • Contactors mechanically and/or electrically interlocked?

  • Wiring diagram available inside panel?

  • Additional Information

  • Comments

General Building

Floors and Floor covering

  • Store currently free from flooring related issues?

  • Floor and floor covering related issues

  • Note
  • Add media

  • Comments

Walls

  • Store currently free from wall related issues?

  • Wall related issues

  • Note
  • Add media

  • Comments

Ceilings

  • Store currently free from ceiling related issues?

  • Ceiling related issues

  • Note
  • Add media

  • Comments

Skylights

  • Sky lights installed?

  • Store currently free from skylight related issues?

  • Skylight related issues

  • Note
  • Add media

  • Comments

Doors & Gates

  • Doors and gates operational without visual damage noted?

  • Door and Gate related issues

  • Note
  • Add media

  • Comments

Carpentry

  • Cupboards and drawers free from damage and/or malfunction?

  • Carpentry defects

  • Note
  • Add media

  • Comments

Turnstiles

  • Turnsiles installed

  • Turnstile
  • Add media

  • Location installed

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Turnstile operational?

  • Comments

Roller shutter doors

  • Roller shutter doors installed

  • Roller shutter door
  • Add media

  • Location installed

  • Manufacturer

  • Model

  • Serial

  • Additional Information

  • Roller shutter door operational?

  • Manual override installed?

  • Gears & chains greased and guards in place?

  • Comments

Plumbing

  • Store currently free from plumbing related issues?

  • Plumbing issues noted

  • Note
  • Add media

  • Comments

Electrical

Distribution boards

  • Distribution Boards Installed

  • DB
  • Add media

  • Location Installed

  • Main Breaker details

  • Additional Information

  • Lightning/ Surge Protection Devices installed?

  • Device status in normal condition?

  • Legends available in panels?

  • Distribution panel accessible?

  • Comments

Power Factor Correction

  • Add media

  • Location Installed

  • Manufacturer of controller

  • Controller Model/ Series

  • Capacity

  • Additional Information

  • Power Factor Correction panel ON and functional?

  • PFC value

  • Number of stages active?

  • Last service date

  • Comments

Lighting

  • Light control switches functional?

  • Lighting free from defects?

  • Defects

  • Note
  • Add media

  • Comments

  • Additional information

  • Comments

UPS Equipment

  • UPS Equipment Installed

  • UPS
  • Manufacturer

  • Model

  • Serial

  • Capacity in kVA

  • System calculated backup time (If displayed by controller)

  • Additional Information

  • Rectifier and Inverter in ON position?

  • UPS in normal operation with Bypass in Open position?

  • Display panel free from alarms and faults?

  • System in good clean condition?

  • Comments

Building management system

  • Building Management system installed?

  • Main panel ON, free from alarms and information active on PLC?

  • Lighting control stations in Facilities and Store entrance functional?

  • Comments

Electric fence

  • Add media

  • Energizer

  • Location Installed

  • Manufacturer

  • Model

  • Serial

  • Output

  • Additional Information

  • Energizer visually in good working condition?

  • Electric fence visually in good condition without line breaks/ crossed lines?

  • Fence on gate connect with fence when gate is closed ?<br>(visually check connection)

  • Comments

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.