Information

  • Z- Tech Ref: Q

  • Asset Name/OMS Number:

  • Site Name:

  • Conducted on

  • Personnel

CUSTOMER INFORMATION

  • Customer

  • Type of Work

  • Type of work

SITE INFORMATION

  • Address
  • GPS Position

  • Access Requirements

  • Special Arrangements details

  • Control Centre

  • Details

CHAMBER DETAILS

  • Cover Lifters

  • Chamber Type

  • Other details

  • Chamber Size (H x W x D)

  • Pipe OD

  • Pipe Material

  • Other details

  • Confined Space

  • Entry Type

  • Other details

FLOWMETER DETAILS

  • Manufacturer

  • Sensor Serial No.

  • Sensor Installation Photos

  • Chamber Location Photos

  • Flow Converter Serial No.

  • Flow Converter Installation Photos

  • Flow Converter Location Photos

  • Telemetry Method

  • Radcom ID

  • RTAP Alias

  • Rack No

  • Slot No

  • Input No

  • Logger Manufacturer

  • Model

  • Model

  • Details

  • Other Details

  • Protocol

  • RTU/PLC Type

  • Model

  • Model

  • Model

  • Model

  • Details

  • Operating Units

  • Operating Range

  • Output Range

  • Pulses/unit

  • Power Supply

  • Supply Voltage

  • Taken from? (DB No/Spur or other)

  • Auxilliary Outputs

Verification Details

  • Secondary Verification

  • Verification position Photos

  • Location Details

  • Location Rating

  • Poor (low-confidence) location details?

  • Test Equipment

  • Serial No.

  • No. of Paths

  • No. of Traverses

  • Set up Quality (Diagnostics)

  • Cause of poor set up Diagnostics?

  • Loop Check

  • Bi-Directional?

  • -100% Actual

  • -50% Actual

  • 0 Actual

  • 50% Actual

  • 100% Actual

  • 0% Actual

  • 25% Actual

  • 50% Actual

  • 75% Actual

  • 100% Actual

  • Manufacturers Diagnostic Check

  • Device

  • Check if "PASS"

  • Cause of failure?

  • Flow Converter Output Logged

  • Visual Inspection carried out

  • IP Check (seals, glands & potting)

  • Action taken?

  • Earthing & Bonding

  • Action taken?

  • Terminations & Insulation

  • Action taken

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.