Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

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GHAZIABAD I&C

  • - Type of Connection (Commercial / Industrial) :

  • - Contract Pressure:

  • - Address:

  • - MRS CHECK POINTS

  • WALL MOUNTED

  • MRS SKID

  • LOCATION OF MRS

  • a) Outside the premises

  • b) Just Inside the premises (Inner side of

  • premises)

  • c) Inside the premises : (Approx. Length of MDPE

  • boundary wall )

  • Condition of MRS

  • OK / NOT OK

  • Any TAP-OFF point in UPSTREAM of Meter

  • YES / NO

  • Seal Status of Meter & Regulator

  • OK / NOT OK

  • By-Pass line closed & Sealed

  • YES / NO / NA

  • Cage & Lock Status

  • OK / NOT OK

  • Electrical Installation near MRS

  • YES / NO

  • Clear Accessibility to MRS

  • OK / NOT OK

  • Safety Sign boards Availability

  • YES / NO

  • - IPW AND SAFETY CHECK POINTS

  • IPW Painting/Clamping/Rusting etc. Status

  • OK / NOT OK

  • IPW Concealed

  • YES / NO

  • Electrical cables/socket nearby IPW

  • YES / NO

  • Proper Ventilation available

  • YES / NO

  • Fire Extinguisher availability

  • YES / NO

  • - TOTAL NOS. OF EQUIPMENTS/APPLIANCES RUNNING ON NATURAL GAS

  • BURNER

  • OVEN

  • BOILER

  • THERMOSTAT

  • OTHERS

  • - AVAILABILITY/ARRANGEMENT OF ALTERNATE FUEL

  • YES/NO

  • Name of Alternate Fuel -

  • Remarks

  • - SAFETY OBSERVATION (if any)

  • REMARKS:

  • - NAME:

  • - DESIGNATION:

  • - SIGNATURE:

  • - CUSTOMER

  • - IGL PNG REPRESENTATIVE

  • - FIRE & SAFETY

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