FRSA - Installation Service Record

• Pump & Motor Installation Details

• Blyde Canyon A Forever Resort - Maintenance Department

• Conducted on

  Date

• Prepared by

Resort / Property Details

• Resort / Property Name

• Technical Manager Name

• Installation Name (eg: Pump Station 1)

• Inspection Date

  Date

Pump Details

• Photo reference

  Media

• Make & Model number

• Serial number

• Is this a Primary or a Backup Pump?

  Primary Pump

  Back Up Pump

• Estimated or known age in years

• Is the Pump in a working Condition?

  Yes

  No

• Last Service Date?

  Date

• Next Service Date

  Date

• Bearing and Packing Details

• Bearing Images

  Media

• Impeller & Shaft Details

• Impeller Images

  Media

• Service Notes & Breakdown History

Pump Motor Details

• Motor Images

  Media

• Make & Model number

• Serial number

• Motor Output

• Is this a Primary or Back up Motor?

  Primary Motor

  Back up Motor

• Is the Motor in a working Condition?

  Yes

  No

• Last Service Date?

  Date

• Next Service Date?

  Date

• Service Notes & Breakdown History

Signatures

• Inspection Conducted By

• Signature

  Sign