Forth River Pump Station P.M. Checklist

• Document No.

• Audit Title Forth P.M. Checklist.

• Conducted on

  Date

• Prepared by

ACCESS

• Access gate secure & locked?

  Yes

  No

  N/A

• Access road condition ok?

  Yes

  No

  N/A

• Access road verges clear?

  Yes

  No

  N/A

• Road entry sight distances are unobstructed by vegetation?

  Yes

  No

  N/A

PUMP STATION BUILDING EXTERNAL

• Access doors secure & locked?

  Yes

  No

  N/A

• Parking area fence secure?

  Yes

  No

  N/A

• Building structural condition ok?

  Yes

  No

  N/A

• Earth stake connected & in good condition?

  Yes

  No

  N/A

• There is no debris or equipment lying around that could be a slip/trip hazard?

  Yes

  No

  N/A

• Weeds controlled & low fire risk?

  Yes

  No

  N/A

TRANSFORMER

• Damage or signs of vandalism?

  Yes

  No

• Danger High Voltage signs in place and in good condition?

  Yes

  No

  N/A

• Transformer no sign of leakage?

  Yes

  No

  N/A

Pumps

• Electric motors greased as scheduled?

  Yes

  No

  N/A

• Pump glands adjusted correctly?

  Yes

  No

  N/A

Valves and Fittings

• Non - return valves operating correctly?

  Yes

  No

  N/A

• valves and fittings free of leaks?

  Yes

  No

  N/A

• Test operate Isolating Valves annually (October)

  Yes

  No

  N/A

• Anti-cavitation valve operating correctly?

  Yes

  No

  N/A

River Intake

• No material blocking river intake?

  Yes

  No

  N/A

• Evidence of tampering with access hatch?

  Yes

  No

• Confined space is labelled?

  Yes

  No

  N/A

• Safety barrier is present and able to be easily accessed for use?

  Yes

  No

  N/A

Fire, Safety & Environment

• Pump room fire extinguishers charged & serviced?

  Yes

  No

  N/A

• Internal & external lighting operating correctly?

  Yes

  No

  N/A

• Exit lighting operating correctly?

  Yes

  No

  N/A

• Fire alarm system in operation and checked within last month?

  Yes

  No

  N/A

• Fire extinguisher(s) checked within last 6 months and is current?

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• E-stop(s) checked? Date?

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• Access doors are unobstructed?

  Yes

  No

  N/A

• Any chemicals, fuels or oils are stored in a bunded area and MSDS is available on site?

  Yes

  No

  N/A

• Electrical equipment, plugs and extension leads are tagged and tested?

  Yes

  No

  N/A

• Work areas are tidy and free of rubbish?

  Yes

  No

  N/A

Completed by

• Completed by:

  Sign