Information

  • Weekly/Monthly Emergency Generator Inspection & Test Report

  • Document No.

  • UMMS Shore Medical Pavilion

  • 125 Shore Way Drive
  • Conducted on

  • 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

  • Date of Inspection:

  • 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.

  • Prime Mover/Generator

  • 1) Free of debris or foreign objects?

  • 2) All fittings and connections are tight?

  • 3) Guards and related components are intact?

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

  • 5) Belts and hoses are in satisfactory condition?

  • Oil

  • 1) Engine oil level is satisfactory?

  • 2) Lube oil heater is satisfactory?

  • 3) Oil operating pressure is above 40 psi?

  • Fuel

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

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

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

  • Cooling System

  • 1) Coolant level is satisfactory?

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

  • Battery System

  • 1) Electrolyte level is between 1250-1275?

  • 2) Specific gravity level is satisfactory?

  • 3) Battery is free of corrosion?

  • 4) Battery charger is functioning properly?

  • Electrical System

  • 1) Wiring and connections are in satisfactory condition?

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

  • Exhaust System

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

  • Record notes here.

  • Include photos here if necessary.

Monthly Emergency Generator Tests

  • Date of monthly test.

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

  • 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?

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

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

  • Record notes here.

  • Include photos here if necessary.

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

  • Select date

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