Trane Madison Facility Condition Assessment

• Report Title:

• Client/Site:

• Conducted on

  Date

• Prepared by

• Describe the general impression of the facility:

• What is the facility sign(s) condition?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is there a preventive maintenance program in place to maintain this asset?

  Yes there is a program

  No it is Fix on Fail

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Does the facility have blueprints?

  Yes

  No

  N/A

• How many occupied buildings?

• How many outbuildings?

• Is the location equipped with a CCTV system?

  Yes

  No

  N/A

• Describe the system and related equipment, provide the service contractor contact information.

• Does the location have manned security?

  Yes

  No

  N/A

• Describe the shifts covered, number of security guards and the contractor contact information

• Does this location have a burglar alarm?

  Yes

  No

  N/A

• Is there a monitoring agreement in place?

  Yes

  No

  N/A

• Provide the contact information and details

• General Comments

• What is the general overall condition of the visitor entrance?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Photo's of Main Enterence

  Media

• Does the front entrance have an automatic opening door that is ADA compliant?

  Yes

  No

  N/A

• Does the front entry have a mag-lock or other security measure?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?<br>

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Does the entrance require and/or have a card access system installed?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?<br>

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Are there any trip hazards near the entrance?

  High Risk

  Mid Level Risk

  Low Risk

  None

• Is there any potential for the entrance to pose a fall risk?

  High Risk

  Mid Level Risk

  Low Risk

  None

• Is the facility entrance equipped with handrails to access safely?

  Yes

  No

  N/A

• Are there any modifications needed to the facility entrance to meet the code?

  Yes there are / is

  N/A

  Not at this time

• Overall condition and assessment of the location's main entrance?

• What type of construction is the exterior of the facility?

  Select Stucco / EFIS Wood Siding Cement / Percast Steel Brick Other/Mixed

  • Stucco / EFIS
  • Wood Siding
  • Cement / Percast
  • Steel
  • Brick
  • Other/Mixed

• What is the condition of the paint and / or finish on the exterior of the building?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the soffit?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the facia?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What type of windows are installed?

  Wood

  Vinyl

  Aluminum

  Fiberglass

• Are all windows double pane?

  Yes

  No

  N/A

• List type and location of windows:

• Are all windows in working condition with screens and latches?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?Define the maintenance service currently preformed?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Do all windows and doors positively shut and latch (applicable code)?

  Yes

  No

  N/A

• What is the overall condition of the structure?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are there any safety concerns related to the structure?

  Yes there are / is

  N/A

  Not at this time

• Describe the safety concerns:

• Take photos of the safety concern.

  Media

• Overall condition and assessment of the exterior structure and envelope?

• What is the general condition of the parking lot(s)?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Are there specific areas that need repairs?

  Yes there are / is

  N/A

  Not at this time

• List each area and provide pictures of needed work:

• Is the parking lot and building exterior adequately lit at night for security? (1-5 fc)?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Do all parking areas have bumpers or curbs?

  Yes

  No

  N/A

• What condition is the parking lot line striping?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are all ADA markings or signs clear and to code?

  Yes

  No

  N/A

• What is the general condition of the facility's sidewalks?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are there any specific sidewalk repairs needed?

  Yes there are / is

  N/A

  Not at this time

• Describe needed repairs and attach pictures:

• Are all sidewalks ADA complaint with ramps as required?

  Yes

  No

  N/A

• Is the garbage area clean and free of odors?

  Yes

  No

  N/A

• Does the facility use a trash compactor?

  Yes

  No

  N/A

• Describe the condition of the trash compactor:

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Overall condition and assessment of the paved surfaces and parking?

• What is the general condition of the facility's landscaping?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Please describe the conditions that are poor or in need of replacement:

• Who is the facility landscape contractor(provide contact number)?

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Is there a functioning irrigation sprinkler system?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Does the irrigation system have monitors or controls?

  Yes

  No

  N/A

• Describe the system and schedule if applicable:

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Overall condition and assessment of the location landscaping?

• Does the facility have any fences on the property?

  Yes

  No

  N/A

• What is the general condition of the fences on the property?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Do all gates open and close properly?

  Yes

  No

  N/A

• Is panic hardware installed on any secured gates if they are in an evacuation pathway?

  Yes

  No

  N/A

• Are there any repairs needed?

  Yes there are / is

  N/A

  Not at this time

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?<br>

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Overall condition and assessment of the location fencing

• What is the general condition of the roof?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Describe the roof composition(3-tab, membrane, tile ect.) of each section as appropriate and age:

• Are there any spots with significant ponding of water?

  Yes there are / is

  N/A

  Not at this time

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Are drains installed to avoid standing water?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Are trees cut back 3 feet from roof-line?

  Yes

  No

  N/A

• Is there a preventive maintenance program in place to maintain this asset?

  Yes

  No

  N/A

• Define the maintenance service currently preformed?

  Select Full PM Services are preformed at this time Particle PM preformed at this time Only Visual Inspection are preformed

  • Full PM Services are preformed at this time
  • Particle PM preformed at this time
  • Only Visual Inspection are preformed

• What is the quality of the services provided?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Does the roof need to be cleaned or does equipment need to be removed?

  Yes there are / is

  N/A

  Not at this time

• Are all gutters clean and draining properly?

  Yes

  No

  N/A

• Are splash-blocks or site drainages positioned for each downspout?

  Yes

  No

  N/A

• Overall condition and assessment of the roof, gutter and drainage systems?

• Does the facility have a dedicated reception area?

  Yes

  No

  N/A

• What is the condition of the flooring in the lobby area (take picture and note type of material)?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the flooring in the corridors (take pictures and note what type of material?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the general condition of the common spaces (walls, wall covering, artwork ect)?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is the lighting in the common spaces adequate?

  Yes

  No

  N/A

• What is the general condition of the handrails?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the doors in the corridor?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Describe needed repairs or improvements and take pictures as appropriate:

• Are all door and bathrooms ADA lever set door knobs?

  Yes

  No

  N/A

• Are all facility entrances and exits secured or able to be secured by staff?

  Yes

  No

  N/A

• Describe needed repairs or changes to provide for adequate security:

• Does the staff have any concerns regarding security?

  Yes there are / is

  N/A

  Not at this time

• Describe specific concerns and staff names for follow-up:

• Overall condition and assessment of the location's interior?

• What is the general condition of all general offices and cubicles?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the flooring in the general offices, conference rooms and cubicles?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Describe the flooring type and the age for the general offices, conferences rooms and cubicles:

• What is the general condition of the plumbing fixtures in the restrooms?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the condition of the facility equipment?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are there specific repairs observed that would rise to a capital level?

  Yes there are / is

  N/A

  Not at this time

• Please describe the specific repairs or equipment needed and provide photo graphs and documentation as appropriate:

• Overall condition and assessment of the office and cubicles:

• What is the general condition of the fire alarm system?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Make:

• Model:

• FACP Location:

• Installed Date:

• Is the fire alarm system addressable or zoned?

  Addressable

  Zoned

  Mixed/Other

• Describe the system and the locations each portion serves:

• Is the alarm tested annually by a certified alarm contractor?

  Yes

  No

  N/A

• Is there currently a service agreement in place?

  Yes

  No

  N/A

• Exceed the code requirement

  Meet the code requirement

  Is below the code requirement

• Overall condition and assessment of the fire alarm system:

• Are portable fire extinguishers inspected monthly?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Are portable fire extinguishers inspected and tested annually?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Are portable fire extinguishers and fire hose reel locations identified and marked?

  Yes

  No

  N/A

• Are portable fire extinguishers and fire hose reels accessable?

  Yes

  No

  N/A

• Is there a sprinkler main exterior loop and PIV system at this location?

  Yes

  No

  N/A

• What is the conditon of the loop, has there been leaks?

  Yes there are / is

  N/A

  Not at this time

• In the past 3 years how many leaks have occured?

• What is the general condition of the loop?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are the PIV valves exercised at least annually?

  Yes

  No

  N/A

• Are hydrants on the main loop?

  Yes

  No

  N/A

• Are the hydrants flushed at least annually?

  Yes

  No

  N/A

• Is the location equipped with a sprinkler system(s)?

  Yes

  No

  N/A

• Is the system being inspected on a quarterly basis by a certified sprinkler company?

  Yes

  No

  N/A

• Are the annual sprinkler inspections and testings performed by a certified sprinkler company?

  Yes

  No

  N/A

• Are codes required weekly and monthly visual inspections preformed and documented?

  Yes

  No

  N/A

• Has the three and five year inspections and testing been completed? and are documents available?

  Yes

  No

  N/A

• Does the location have a dry pipe system(s)?

  Yes

  No

  N/A

• Is the system being inspected on a quarterly basis by a certified sprinkler company?

  Yes

  No

  N/A

• Are the annual sprinkler inspections and testing performed by a certified sprinkler company?

  Yes

  No

  N/A

• Are codes required weekly and monthly visual inspections preformed and documented?

  Yes

  No

  N/A

• Has the three and five year inspections and testings been completed and are documents available?

  Yes

  No

  N/A

• Does the location have a pre-action system(s)?

  Yes

  No

  N/A

• Is the system being inspected on a quarterly basis by a certified sprinkler company?

  Yes

  No

  N/A

• Are the annual sprinkler inspections and testing performed by a certified sprinkler company?

  Yes

  No

  N/A

• Are codes required weekly and are monthly visual inspections preformed and documented?

  Yes

  No

  N/A

• Have the three and five year inspections and testings been completed and are documents available?

  Yes

  No

  N/A

• Does the location have a clean agent system?

  Yes

  No

  N/A

• Is there other fire protection elements at this location not noted above? If so what are the conditions?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is the system being inspected in accordance to code requirement by a certified company?

  Yes

  No

  N/A

• Please describe the system and the area covered by the system:

• Are code required inspections documented?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• What is the overall condition of the fire protection systems at this location?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Overall condition and assessment of the fire protection systems:

• Does the location have a paging system?

  Yes

  No

  N/A

• Describe the general condition of the paging system(s)

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are there any specific repairs needed for the system to remain operational?

  Yes there are / is

  N/A

  Not at this time

• What is the overall assessment of the system?

• Does the facility have any electrical issues currently?

  Yes there are / is

  N/A

  Not at this time

• Describe issues or repairs needed (photos as needed).

• Has the facility had the electrical service inspected and thermal scan per NFPA 70 in the past 5 years?

  Yes

  No

  N/A

• Is there any Electrical Preventive Maintenance performed?

  Yes

  No

  N/A

• Define the PM type(s)

• At what level is preventive maintenance performed?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• What is the quality level of the maintenance performed?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Does the facility have a lockout/tag out program and current training?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Are quarterly inspections and logs of GFI testing being done?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Overall condition and assessment of the electrical systems:

• Does the facility have an emergency generator?

  Yes

  No

  N/A

• Describe the general condition of the Generator and Automatic Transfer Switch:

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Location:

• Make:

• Model:

• Approximate Age:

• Size(KW):

• Fuel Type:

  Select Gas Diesel Natural Gas Propane

  • Gas
  • Diesel
  • Natural Gas
  • Propane

• Are there any repairs that are needed immediately?

  Yes there are / is

  N/A

  Not at this time

• Is there currently any preventive maintenance performed?

  Yes

  No

  N/A

• Define the Preventive Maintenance type

• What is the level of the Preventive Maintenance performed?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• What is the quality level of the maintenance performed?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Describe the conditions that need repair or replacement immediately:

• Overall condition and assessment of the generator system:

• How many water heaters are on site?

• How many boilers are at this site?

• Is there a water management plan?

  Yes

  No

  N/A

• What is the general condition of the water heating systems?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What water heater or boiler types are in service?

  Select Electric Natural Gas Propane Fuel Oil/Diesel

  • Electric
  • Natural Gas
  • Propane
  • Fuel Oil/Diesel

• Are there any specific hot water repairs or replacements needed?

  Yes there are / is

  N/A

  Not at this time

• Describe needed repairs or replacements and estimate of cost:

• Are all hot water appliances set to deliver the correct temperature of water for their application?

  High Risk

  Mid Level Risk

  Low Risk

  None

• How many mixing valves are in operation (not tempering valves i.e. sinks)?

• Does the facility have a water softening system?

  Yes

  No

  N/A

• Is there any plumbing or sewer repairs needed at this time?

  Yes there are / is

  N/A

  Not at this time

• Describe repairs or replacements needed:

• Has there been any relevant sewer or subterranean issues in the recent past?

  Yes there are / is

  N/A

  Not at this time

• Describe situations and any mitigations performed.

• Overall condition and assessment of the Plumbing Systems:

• What is the general condition of the HVAC systems in the facility?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Are there any units or equipment that is mission critical?

  Yes

  No

  N/A

• Please list the units that are mission critical

• What is the overall condition of the mission critical equipment?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• What is the level of preventive maintenance preform on the mission critical equipment?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is there any specific unit repairs or replacements needed?

  Yes there are / is

  N/A

  Not at this time

• Describe repairs or replacement as necessary:

• Are all the HVAC units labeled indicating coordinating systems?

  Yes

  No

  N/A

• Are all HVAC filters dated and replaced per their PM schedule?

  Yes

  No

  N/A

• Are all exhaust fans functioning and clean?

  Yes

  No

  N/A

• Is any exposed duct work leaking or showing signs of deterioration?

  Yes there are / is

  N/A

  Not at this time

• Are all HVAC discharges and returns balanced and clean?

  Yes

  No

  N/A

• Offices and conference Rooms Cooling is provided by what type of system (select all as needed)?

  Select DX System Fan Coil VRF PTAC None Window AC

  • DX System
  • Fan Coil
  • VRF
  • PTAC
  • None
  • Window AC

• Does the facility have designated plans to provide alternate heating / cooling during extreme weather?

  Yes

  No

  N/A

• Overall comments and assessment of HVAC systems:

• What is the condition of the air compressor system?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Describe the conditions that need attention:

• Are the compressed air systems inspected and tested annually by certified mechanics?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is there currently a preventive maintenance leak check of the system.

  Yes

  No

  N/A

• How often is the leak / performance testing performed?

• What was the results for the last test

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is there a weekly or monthly preventive maintenance inspection schedule?

  Yes

  No

  N/A

• What it the level of the Preventive Maintenance performed?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• How is the quality of the PM preformed?

  High Quality

  Acceptable Quality

  Low Quality

  Needs Immediate Attention

• Are inspections documented?

  Yes

  No

  N/A

• Are there any code issues that need to be resolved?

  Yes there are / is

  N/A

  Not at this time

• What is the overall condition assessment of the system?

• Does the facility have an elevator?

  Yes

  No

  N/A

• How many elevators are on site?

• Who is the service company?

• Are any of them critical to Production needs

  Yes

  No

  N/A

• At what level is PM preformed

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• When was the last date of service?

  Date

• Was the service completed in the last 12 months?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Is the permit current and on file?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Was the elevator shaft and sump clean?

  Yes

  No

  N/A

• Are there any maintenance, repairs or safety issues that need to be taken care of?

  Yes there are / is

  N/A

  Not at this time

• Describe the issues that need to be resolved:

• Overall condition and assessment of the elevator(s):

• General safety conditions of the sites:

  Safe

  At Risk

  N/A

• General safety comments:

External hazards or environmental issues:

• Do any exterior risks or hazard exist?

  Yes there are / is

  N/A

  Not at this time

• Describe conditions:

• Take photo if applicable.

  Media

• Are there any external environmental issues noted?

  Yes there are / is

  N/A

  Not at this time

• Describe conditions:

• Take photos if applicable.

  Media

Internal risk and environmental issues:

• Has there been any asbestos containing material identified and removed previously?

  Yes there are / is

  N/A

  Not at this time

• Is there any remaining asbestos containing material still on the property?

  Yes there are / is

  N/A

  Not at this time

• Detail what materials and locations, or attach asbestos report if available.

• What is the general air quailty of the site?

  High Risk

  Mid Level Risk

  Low Risk

  None

• Describe the conditions:

• Take photos if applicable.

  Media

• What is the general water quality of the site?

  High Risk

  Mid Level Risk

  Low Risk

  None

• Describe the conditions.

• Provide photos if possible.

  Media

• Are there any other internal enviornmental issues noted?

  Yes there are / is

  N/A

  Not at this time

• Describe conditions:

• Take photos if applicable.

  Media

• Describe the overall safety level of the site and any issues noted:

• What is the general condition of the kitchen or break room?

  N/A

  Good

  Poor

  Fair

  Immediate attention needed

• Is the kitchen or break area clean and organized?

  Yes

  No

  N/A

• Does this site have a full service kitchen?

  Does

  Dose Not

• Is there an exhaust hood at this location?

  Yes

  No

  N/A

• What type of fire suppression system is installed in the kitchen hood?

  Water

  Dry Chem

  CO2

  UL300

• What is the make of the suppression system?

• What is the model of the suppression system?

• Has the kitchen hood and suppression system been inspected every 6 months by a service company?

  Yes

  No

  N/A

• Service Date #1: (mm/dd/yy)

• Service Date #2: (mm/dd/yy)

• Has the kitchen hood been cleaned in the last 12 months?

  Yes

  No

  N/A

• Are all hood baffles tightly fitting with no gaps or movement when unit is turned on?

  High Risk

  Mid Level Risk

  Low Risk

  None

• Is the facility equipped with a dish washing machine?

  Yes

  No

  N/A

• Is the dish machine a high temp (booster) or low temp (chemical injection) machine?

  High Temp

  Low Temp

• Has the booster been serviced in the last 6 months?

  Yes

  No

  N/A

• Does the dish washing machine records indicate that the rinse temp reaches 180 F?

  Yes

  No

  N/A

• Does the final rinse temp exceed 120 degrees, and do records indicate chlorine level is above 200 ppm?

  Does

  Dose Not

• Does the facility have a deep fryer?

  Yes

  No

  N/A

• Is that equipment kept under the hood and at least 16" from any potential ignition source?

  They are Compliant

  They are Partly Compliant

  Not In Compliance

• Has the facility experienced any fats, oils, or grease issues requiring service work?

  Yes

  No

  N/A

• Does the facility have a grease trap?

  Does

  Dose Not

• Is the trap being routinely maintained and are records available?

  Yes

  No

  N/A

• Describe the location and type of grease trap

• Is the facility equipped with an ice machine(s)?

  Yes

  No

  N/A

• Is the equipped ice machine drained, cleaned, and are filters checked quarterly?

  Yes

  No

  N/A

• Is there any kitchen equipment that needs to be repaired or replaced?

  Yes there are / is

  N/A

  Not at this time

• Describe the needed repairs or replacements and photograph as necessary.

• How many Reach-in Refrigerators are onsite?

• How many Reach-in Freezers are onsite?

• How many Walk-in Refrigerators are onsite?

• How many Walk-in Freezers are onsite?

• What is the average age of the refrigeration equipment?

• Overall condition and assessment of the kitchen, break area and equipment:.

• Are there any other facility issues or needs that should be documented?

  Yes there are / is

  N/A

  Not at this time

• Describe any Issues and potential options:

Other Issue:

• Describe any Issues and potential options:

Recommendations / Opportunities

• Opportunity

Add opportunity

• Opportunity

• Assessor general comments and recommendations:

• Add signature

  Sign

• what is the general condition of the exterior?

  Select Baseboard Cadet Heater PTAC Fan Coil DX System VRF

  • Baseboard
  • Cadet Heater
  • PTAC
  • Fan Coil
  • DX System
  • VRF

• Define the HVAC that is required for Production Operations

• Are / is there a chiller(s) required for cold water to support production?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Are / is there a cooling tower(s) required for cold water to support production?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is water treatment being preformed at this time?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Are / is there other humidity control system to support production?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is water treatment being preformed at this time?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is there any additional water treatment being preformed at this time?

  Yes

  No

  N/A

• What is the level of water treatment performed

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• What is the overall assessment of the Production HVAC System?

• Are / is there a cooling tower(s) required for cold water to support production?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is water treatment being preformed at this time?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Are / is there a cooling tower(s) required for cold water to support production?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only

• Is water treatment being preformed at this time?

  Yes

  No

  N/A

• What is the level of PM preformed on this / These units?

  Preforming Above PM standard

  Preforming at PM standard

  Preforming Below PM standard

  Preforming at Fix on Fail Only