Information

  • Z- Tech Ref: Q

  • Asset Name/SOM Number:

  • Site Name:

  • Conducted on

  • Personnel

CUSTOMER INFORMATION

  • Customer

  • Type of Work

  • Thames Water SAP Id:

  • 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)

  • Chamber Condition

  • Type Of Pump Required

  • Enter Requirements

  • Pipe OD

  • Pipe Material

  • Wall Thickness

  • Wall Thickess

  • Wall Thickness

  • Wall Thickness

  • Wall Thickness

  • Wall Thickness

  • Liner Information

  • Steel Type

  • Wall Thickness

  • Wall Thickess

  • Wall Thickness

  • Liner Information

  • Other details

  • Confined Space

  • Entry Type

  • Other details

FLOWMETER DETAILS

  • Process Flowmeter

  • ICA & PTW Required

  • Manufacturer

  • Calaray Flowmeter Type

  • Krohne Flowmeter Type

  • ABB Flowmeter Type

  • Location ID

  • FI Value

  • FP Value

  • Location ID

  • FI Value

  • FP Value

  • Fischer & Porter Flowmeter Type

  • Panametrics Flowmeter Type

  • Siemens Flowmeter Type

  • Kent Flowmeter Type

  • Sarasota Model Number

  • Danfoss Model Number

  • 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

  • Quality Of Diagnostics

  • Reason For Poor Diagnostics

  • Location ID

  • Location FI

  • Location FP

  • Quality Of Installation Location

  • Reason For Poor Location

  • Number Of Traverses Completed (Minimum Of Ten Required)

  • Flow Converter Output Logged

  • Visual Inspection carried out

  • IP Check (seals, glands & potting)

  • Action taken?

  • Manufacturers Diagnostic Check

  • Serial No.

  • Earthing & Bonding

  • Action taken?

  • Terminations & Insulation

  • Action taken

  • Loop Check

  • Bi-Directional?

  • 0% Actual

  • 25% Actual

  • 50% Actual

  • 75% Actual

  • 100% Actual

  • -100% Actual

  • -50% Actual

  • 0% Actual

  • 50% Actual

  • 100% Actual

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.