Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

PROJECT:

  • Jobsite

  • Location

  • Client

VERIFICATION:

  • 1. Correct pump for use .

  • 2. Correct pump delivered

  • 3. Damage to pump

MOUNTING OF PUMP

  • 1. Pump location as per drawing

  • 2. Correct mounting bracket used

CONNECTING OF PUMP TO WATER SUPPLY AND HYDRANT SYSTEM:

  • Correct material used

  • 2. Pipe brackets as required

  • 3. All pipework completed in area

  • 4. All pipe work pressure tested

CONNECTION OF DRAIN LINES TO PUMP

  • 1. Correct material used

  • 2. Pipe brackets as required

  • 3. All drains connected

  • 4. Drained to approved location

CONTROL PANEL

  • 1. Control panel mounted in accessible location

  • 2. Control panel securely fixed

  • 3. Power supply connected to panel

EXHAUST SYSTEM:

  • 1. Exhaust system connected to motor

  • 2. Exhaust run to approved location

  • 3. Exhaust bracketed as require

  • 4. Material approved for use

  • 5. Exhaust wrapped with approved material

COMMISSIONING:

  • 1. Pump commissioned by supplier

  • 2. Diesel tank filled

  • 3. Water supply turned on

  • 4. Electrical supply turned on

  • 5. All valves locked with 003 locks

  • 6. All pressure gauges working and visible

  • 7. Saficant ventilation in pump room

  • 8. Pump operating correctly

SIGN OFF

  • CHECKED BY:

  • SIGNATURE

  • REVIEWED BY

  • DATE:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.