Title Page

  • Audit Title

  • Time In

  • Time Out

  • Prepared by

  • Location
  • Document No. F10041 Rev 1/2017 DED

Maintenance Log Checklist

  • Instructions:
    1. Answer "Yes" or "No" for the questions below.
    2. Add photos and notes by clicking on the paperclip icon.
    3. To add a Corrective Measure 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.
    5. Share your report by exporting as PDF, Word, Excel or Web Link.

Maintenance Log Checklist

  • "Nitrification Tower Transfer Pump<br>Operational ?"

  • Nitrification Tower Diffusers Cleaned ?

  • Chlorine Contact Chamber Cleaned? (Every Visit)

  • Blowers Operational

  • Air Diffusers Cleaned ?

  • Both Effluent Pumps Operational ? (Every Visit)

  • Chlorine/Dchlor Tablets Replenished? (As Needed)

  • Effluent Pumps #1 Hours

  • Effluent Pumps #1 In Good working order?

  • Effluent Pumps # 2 Hours?

  • Effluent Pumps # 2 In Good working order?

Quality Control Test

  • Ammonia Level:

  • Test Strips used or Kit (Choose one from the dropdown list)

  • Aeration Basin pH: (General Rule pH 7.5-8.0)

  • <br><br>Samples Collected?

  • Effluent pH - S.U.

  • Effluent D.O. - mg/l

  • Effluent CI2 - mg/l

  • Flow - MGD



  • Signed By

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.