A1 Equipment Inspection Audit REV 3

• Take a photo of store.

  Media

• Project No.

• Report Title,Target element i.e AHU, BOILERS, ANSUL, OVERDOOR HEATERS

• Client Prepared For - Company

• Client Work Order / Purchase Order

• Location/Property
  Address

• Have you log in to Verisae system ( on site)

• Conducted on

  Date

• Prepared By

• Air Handling Unit (AHU)

AHU

• Equipment Nameplate or AHU Photo and location

  Media

• Make / Model / Serial Number

• Yes

  No

  N/A

• Yes

  No

  N/A

• Heat/Cool or Cooling Only Equipment

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Is there electrical power to the unit?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Electrical Disconnect Condition (saftey)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Is there natural gas to the unit? What is it conditaion overall

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Is the unit assessable for maintenace ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect Gas Valve Operation

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Heating Safeties

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Inducer or Combustion Motor

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Fan Motor condition ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect Heating or cooling coil ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect Ductwork condition / leakage rate ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check air temperture- flow

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check air temperature retrun

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Equipment Filter(s)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Equipment Belt(s)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Test Thermostat Operation

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Overall Equipment Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Equipment Inspection Recommendations & Notes

• Is the unit/fixture to be retained?

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise of what remedial works are required (if any)? (List)

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise on expected lifespan of fixture?

  Good Condition

  Poor Condition

  Must be Condemed

• Boilers Main store

Boilers store heating

• Equipment Nameplate Photo , Location

  Media

• Make / Model / Serial Number

• General Boiler condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Is there electrical power to the unit?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect Electrical Disconnect Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• What is the condition of the pipework and insulation, take photos (Plant room/flow and return)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Natural Gas Shut-Off Valve in Good Working Condition?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect Gas Valve

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Heating Safeties

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Inspect Heat Exchanger

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Inducer or Combustion Motor

  Good Condition

  Poor Condition

  Must be Condemed

• Visual Inspection of distribution pipework insulation to possible units i.e AHU coils , Back of house heating units , overdoor heaters (Front).

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Visual Inspection of System store pipework

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Equipment Filter(s)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Temperture and Control Panel Operation = what is the set point and flow temperture (delta T)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Overall Equipment Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Equipment Inspection Recommendations & Notes

• Is the unit/fixture to be retained?

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise of what remedial works are required (if any)? (List)

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise on expected lifespan of fixture?

  Good Condition

  Poor Condition

  Must be Condemed
Over Door Heater (ODH) and Back of House (loading door)

• Equipment Nameplate

  Media

• Make / Model / Serial Number

• Accessibility of Unit Heater

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Natural Gas Shut-Off Valve in Good Working Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Inspect Ignition Assembly Parts

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check and Inspect Thermocouple

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Inducer Motor Assembly if possible

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Test Heating Safeties

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check Fan Motor if possible

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Visual Inspection of Heat Exchanger

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Test Thermostat Operation

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Overall Equipment Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Equipment Inspection Recommendations & Notes

• Is the unit/fixture to be retained?

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise of what remedial works are required (if any)? (List)

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise on expected lifespan of fixture?

  Good Condition

  Poor Condition

  Must be Condemed

• ANSUL Fire Suppression System

ANSUL

• Location , Bakery , Staff Kitchen or other ?

  Good Condition

  Replace

  N/A

• Equipment Nameplate Photo

  Media

• Make / Model / Serial Number

• Is system set ok ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check if system has discharge on the panel ? (Take photo)

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Check/Inspect service card on panel normally ? last maintenace inspection date ?

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Visual Inspection of Tube Sections

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Visual Inspection of end nozzle, are they capped? (take photo)

  Good Condition

  Cleaning Required

  Replacement Required

  N/A

• Check/Inspect In-Take & Exhaust Venting (Note if dirty please add as red "fire harzard")

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Overall Equipment Condition

  Good working order

  Needs Maintenace or repair

  Item needs urgent repair or replacement

  N/A

• Equipment Inspection Recommendations & Notes

• Is the unit/fixture to be retained?

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise of what remedial works are required (if any)? (List)

  Good Condition

  Poor Condition

  Must be Condemed

• If Yes, please advise on expected lifespan of fixture?

  Good Condition

  Poor Condition

  Must be Condemed

Other Observations , Note any other details worth reporting. (take photos and notes)

• Good Condition

  Poor Condition

  Must be Condemed

• Good Condition

  Poor Condition

  Must be Condemed

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Good Condition

  Poor Condition

  Must be Condemed

• Good Condition

  Poor Condition

  Must be Condemed

Overall Summery - short statement

• Add signature

  Sign

• Used to assess the condition of existing boilers, AHU, Overdoor heaters equipment/systems on a property to determine if there are any issues that need to be resolved/repaired. KEY = GREEN, a green rating means the health of the system element is basically sound, there are no major barriers to continued operation, no major risk in the near future. AMBER = An amber rating means the element of the system is not fully healthy, Caution required, some specific risks that can be dealt with via maintenance or repair, however active monitoring and additional attention will be required as a priority. RED = a RED rating means the system element is in poor health and needs immediate treatment, one or more specific issues present a major risk to the store, requires close and active involvement by senior management in planning and monitoring.

• Disclaimer
  The assessors believe the information contained within this audit assessment report to be correct at the time of printing. The assessors do not accept responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the assessors during the day of the audit assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made.
  
  Confidentiality Statement
  In order to maintain the integrity and credibility of the audit assessment processes and to protect the parties involved, it is understood that the assessors will not divulge to unauthorized persons any information obtained during this audit assessment unless legally obligated to do so by the client.