HTG Trading Ltd (Hubbard Systems)

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site Staff:

Purchasing Group:

• Name of Client:

Site Contact Details:

• Contact Name for Site:

• Site Telephone number:

Reason for Site Survey:

• Select Reason for replacement Equipment:

  Select Replacement Additional New Supply Existing Relocation

  • Replacement
  • Additional
  • New Supply
  • Existing Relocation

• Site 'Ice' estimate per 24 hours:

• Type of Ice required -

  Supercube

  Dice

  Superdice

  Flake

  Cubelet

Existing Equipment (Model & Serial Number):

• Current equipment details -

• Why does existing equipment require replacing ?

  Beyond Repair (BER)

  Inadequate Production or Storage

  Other

• Photograph of Existing Equipment.

  Media

• Yes

  No

  N/A

Current Location of Equipment:

• Current location (Cellar, Bar etc) -

• How is the current unit cooled ?

  Air Cooled

  Water Cooled

  Remote Condenser

  Other

• Is equipment to stay in current location ?

  Yes

  No

  N/A

• Is there a good & clear access route to the location (stairs, doors, furniture etc) ?

  Yes

  No

  N/A

• Any requirement for special tooling or lifts to help locate equipment ?

  Yes

  No

  N/A

• How many persons required for the locating and install of equipment ?

  One

  Two

  Three

  More

Suggested Equipment (based on information from this survey):

Equipment Accessories :

• Water filter required ?

  Yes

  No

  N/A

• Condensate pump required ?

  Yes

  No

  N/A

Removal of Existing Equipment:

• Will any redundant equipment require removal ?

  Yes

  No

  N/A

Equipment Service Information:

• Are current services adequate for the equipment:

  Yes

  No

  N/A

• Is current electrical supply adequate ?

  Yes

  No

  N/A

• Water supply terminated with a washing machine style stopvalve ?

  Yes

  No

  N/A

• Waste Drainage suitable for use ?

  Yes

  No

  N/A

• Services - Further comments (if required):

• Please supply any relevant photographs of the units current or intended location:

  Media

Ambient Temperature:

• Enter current ambient temperature of current or intended location:

External Temperature:

• Enter known current external temperature (as a reference):

Health & Safety Information:

• Permit to Work Required ?

  Yes

  No

  N/A

• Method or Risk Assessments Required ?<br>

  Yes

  No

  N/A

• Site Induction Required ?

  Yes

  No

  N/A

• Personal ID or Company Liability Insurance Required ?

  Yes

  No

  N/A

• Name/Position of Site Representative present :

  Sign