DWD PASSTHROUGH DW SURVEY FORM (No Tables)

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Suggested machine

  Select Carlton Master Kromo Hood Aquatec Rapide Maid2wash 50 abs Select 7 Select 7 office Kromo Lux 60

  • Carlton Master
  • Kromo Hood
  • Aquatec Rapide
  • Maid2wash 50 abs
  • Select 7
  • Select 7 office
  • Kromo Lux 60

Old Machine (if any)

• Would you like us to disconnect and dispose of old machine

  Yes

  No

Water

• Is the water supply within One Meter

  Yes

  No - How far away

• Is the machine going on a hot or cold water supply

  Hot

  Cold

• Is the water pressure above 1.5 bar

  Yes

  No

• If no is a rinse boost pump needed.

  Yes

  No

  N/A

• Can you isolate water supply

  Yes

  No

• Pipe Size

  15mm

  22mm

• Water Softener required

  None

  Existing

  Manual

  Auto cold

  Auto hot

Drainage

• Is there a waste pipe within one meter

  Yes

  No - How far away

• Pipe Size

  32mm

  40mm

  52mm

  Larger

• Pipe height off ground

• Material

  Plastic

  Copper

  Metal

• Photo of water and drainage

  Media

Electrics

• Is there a suitable - live power supply within one meter

  Yes

  No - How far away

• Power Supply

  Select 13 amp single Phase 30 amps single Phase 32 amps single Phase 16 amps TP & N 32 amps TP & N 3 phase 3 live 1 neautral + 1 earth

  • 13 amp single Phase
  • 30 amps single Phase
  • 32 amps single Phase
  • 16 amps TP & N
  • 32 amps TP & N
  • 3 phase 3 live 1 neautral + 1 earth

• Insert photo of Isolation

  Media

• Auto Softeners Require separate 13 amp socket, Is there one available

  Yes

  No

  N/A

Tabeling

• Are the existing tables in place

  Yes

  No

• If yes are they fixed to wall/floor or removable

  Fixed

  removable

• Are tables self supporting or machine supported

  Self supported

  Machine supported

• If NO what tables are required

  Uni Soiled 1200mm

  uni Soiled 600mm

  Uni Clean 1200mm

  Uni Clean 600mm

  Bespoke tabling needed

Other Work

• Any Extra work the INSTALLER will do when installing

  Yes

  No

• Extra time in Hours

• Preferred Install Date

  Date

• Services Customer will provide

Customer Signiture

• I confirm, I am responsible for the above requirements and these will be available when the installer returns to install the machine.

  Sign

• Print Name

• Select date

  Date

• Add drawing

  Drawing

• Add media

  Media

Site Survey

• Will the boxed machine go from the outside of the building and into the room

  Yes

  No

• Is the machine on the ground floor

  Yes

  No- How many stairs up/down

• Is help available?

  Yes

  No

• Is there a suitable lift available?

  Yes

  No

• Is there parking available

  Yes

  No

Chemicals

• which are available

  Select Detergent Rinse Aid

  • Detergent
  • Rinse Aid

• If none who will supply?

  existing supplier

  DWD