Emergency Generator Inspection Report for UMMS Shore Medical Pavilion

• Weekly/Monthly Emergency Generator Inspection & Test Report

• Document No.

• UMMS Shore Medical Pavilion

• 125 Shore Way Drive
  Address

• Conducted on

  Date

• Inspection Template Prepared by

• Personnel

General Information

• Information on this form covers the minimum requirements of NFPA 110 (2013) for emergency generators.

• UMMS Shore Medical Building

• Ralph Lindner

  Ted Sacra

  Dan Thomas

  Anthony Carter

• Date of Inspection:

  Date

• Generator Model: MTU 12V1600 DS 600

• Engine Model:

• Date Installed:

• Standby kW nameplate rating:

• 30% of standby rating =

• Fuel type: Diesel

• Normal operating temperature:

Weekly Emergency Generator Inspections

• Date of weekly inspection.

  Date

• Prime Mover/Generator

• 1) Free of debris or foreign objects?

  Yes

  No

  N/A

• 2) All fittings and connections are tight?

  Yes

  No

  N/A

• 3) Guards and related components are intact?

  Yes

  No

  N/A

• 4) Free of unusual vibrations, noise, leaks or signs of deterioration?

  Yes

  No

  N/A

• 5) Belts and hoses are in satisfactory condition?

  Yes

  No

  N/A

• Oil

• 1) Engine oil level is satisfactory?

  Yes

  No

  N/A

• 2) Lube oil heater is satisfactory?

  Yes

  No

  N/A

• 3) Oil operating pressure is above 40 psi?

  Yes

  No

  N/A

• Fuel

• 1) Fuel tank(s) levels are satisfactory?

  Yes

  No

  N/A

• 2) Hoses, piping and connections are free of leaks?

  Yes

  No

  N/A

• 3) Tank vents and overflow piping are intact and free of obstructions?

  Yes

  No

  N/A

• Cooling System

• 1) Coolant level is satisfactory?

  Yes

  No

  N/A

• 2) Water pump, jacket water heater, belts, hoses and fans are in good condition?

  Yes

  No

  N/A

• Battery System

• 1) Electrolyte level is between 1250-1275?

  Yes

  No

  N/A

• 2) Specific gravity level is satisfactory?

  Yes

  No

  N/A

• 3) Battery is free of corrosion?

  Yes

  No

  N/A

• 4) Battery charger is functioning properly?

  Yes

  No

  N/A

• Electrical System

• 1) Wiring and connections are in satisfactory condition?

  Yes

  No

  N/A

• 2) Circuit breakers are clean and in satisfactory condition?

  Yes

  No

  N/A

• Exhaust System

• 1) Drain condensate trap is free of leaks and in satisfactory condition?

  Yes

  No

  N/A

• Record notes here.

• Include photos here if necessary.

  Media

Monthly Emergency Generator Tests

• Date of monthly test.

  Date

• 1) Generator was exercised a minimum of 30 minutes in a manner consistent with NFPA 110 (2013), Section 8.4.2?

  Yes

  No

  N/A

• Record meter reading at start of exercise.

• Record meter reading at end of exercise.

• Record specific gravity level.

• Record oil pressure reading.

• Record operating temperature.

• Record kW load.

• Record time taken for load transfer.

• 2) Transfer switch is free of dust or dirt and in satisfactory condition?

  Yes

  No

  N/A

• 3) Transfer switch was exercised by moving from "normal" position to alternate position and back again.

  Yes

  No

  N/A

• Emergency generator system was returned to normal condition upon completion of test?

  Yes

  No

  N/A

• Record notes here.

• Include photos here if necessary.

  Media

Inspector's Information

• Company: Colliers International

• I state that the information on this form is correct at the time and place of inspection, and that all equipment tested at this time was left in operational condition upon completion of this inspection.

• Add signature

  Sign

• Select date

  Date