Generator Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Generator Survey Information

• Location of survey

  Select Baylor - Aubrey Baptist - Thousand Oaks Baptist - Westover Hills Baptist - Overlook Baptist - Hausman Baptist - Schertz Emerus - Tomball Emerus - Sugarland

  • Baylor - Aubrey
  • Baptist - Thousand Oaks
  • Baptist - Westover Hills
  • Baptist - Overlook
  • Baptist - Hausman
  • Baptist - Schertz
  • Emerus - Tomball
  • Emerus - Sugarland

• Surveyor

• Surveyor's Title

• Surveyor's Signature

  Sign

• On Site Representative

• On Site Representative's Title

• On Site Representative's Signature

  Sign

2. Inspection Type

• Type of inspection

  Monthly

  Annual

3. Generator Information

• What is the date of the last annual inspection?

  Date

• Who was the inspecting company?

• Manufacturer

• Model number

• Serial number

• Fuel source

  Diesel

  Natural Gas

• Fuel level

  Select Full 3/4 1/2 1/4 Empty Continuos

  • Full
  • 3/4
  • 1/2
  • 1/4
  • Empty
  • Continuos

• Oil level

  Full

  3/4

  1/2

  1/4

  Empty

• Coolant level

  Full

  3/4

  1/2

  1/4

  Empty

• Battery condition

  Good

  fair

  Poor

  Needs Replacement

• Was the fuel filter checked for moisture and drained if needed?

  Yes

  No

  N/A

• Is the generator locked and secured?

  Yes

  No

  N/A

• Does the panel log show adequate weekly operation of the generator [NFPA 110: 3.5.1.2.3(b)]?

  Yes

  No

  N/A

• Does the generator log show weekly inspection and maintenance of the batteries [NFPA 99: 3-4.4.1.3]?

  Yes

  No

  N/A

4. Monthly Inspection

• Was the generator tested under full load for at least 30 minutes not less than 20 days between intervals [NFPA 99: 3-4.4.1(b)(1) and 110: 8.4.1.1]?

  Yes

  No

  N/A

• Was the automatic transfer switch operated or exercised during the inspection [NFPA 110: 8.4.5]?

  Yes

  No

  N/A

• Start time of the test

  Date

• Stop time of the test

  Date

• Total run time of the test

• How long did it take for the generator to start [NFPA 99: 3-4.1.1]

• Comments

5. Annual Inspection

• Who was the inspecting company

• Date of last inspection

  Date

• Has evidence of the last annual inspection been noted near the interior ATS or inside the main generator comartment

  Yes

  No

  N/A

• Has notice of the last annual inspection been filed within the hospital log books

  Yes

  No

  N/A

• Was the report free of deficiencies or service items needed

  Yes

  No

  N/A

6. Corrective Actions

• Comments regarding deficiencies or service items needed