INT3000

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by (integra Rep)

• Location
  Address

Details of service

• Service Call Type

  Monthly Scheduled

  Extra Service Request

• Service Performed

  Select Chemical Safety Training Equipment Installation Procedures/Cleaning Manual Amendments Equipment Repair Preventative Service Call Equipment/Chemical Trial

  • Chemical Safety Training
  • Equipment Installation
  • Procedures/Cleaning Manual Amendments
  • Equipment Repair
  • Preventative Service Call
  • Equipment/Chemical Trial

Service Activities

• 1. All MSDSs on site and up to date

  Yes

  No

  N/A

• 2. All AQIS approvals (IOA) on site and up to date

  Yes

  No

  N/A

• 3. Chemical Inventory - order placed

  Yes

  No

  N/A

• 4. Pre-operational check conducted

  Yes

  No

  N/A

• 5. Attended QA/Plant Management meeting

  Yes

  No

  N/A

• 6. Micro swabbing conducted

  Yes

  No

  N/A

Chemical Storage

• 7. Chemical safety signage in view and up to date

  Yes

  No

  N/A

• 8. Storage facility secured when not being accessed

  Yes

  No

  N/A

• 9. Chemicals stored in bunded area

  Yes

  No

  N/A

• 10. Safety shower and eyewash operational

  Yes

  No

  N/A

• 11. All drums labelled and easily identified

  Yes

  No

  N/A

• 12. All containers properly segregated

  Yes

  No

  N/A

• 13. Bund sumps being checked and drained regularly

  Yes

  No

  N/A

• 14. Empty chemical drums removed

  Yes

  No

  N/A

• 15. Chemical store in clean and tidy condition

  Yes

  No

  N/A

• 16. Drums stored with bungs/lids in place

  Yes

  No

  N/A

Chemical Handling

• 17. Appropriate Personal Protective Equipment available

  Yes

  No

  N/A

• 18. Chemical Safety Training completed by all staff

  Yes

  No

  N/A

• 19. Chemical containers labelled or appropriately tagged

  Yes

  No

  N/A

• 20. Hygiene staff wearing appropriate PPE for job

  Yes

  No

  N/A

• 21. Manual dispensing follows correct procedure

  Yes

  No

  N/A

• 22. Manual cleaning aids in good condition

  Yes

  No

  N/A

Equipment Performance

• 23. Dosing pumps in good working order

  Yes

  No

  N/A

• 24. Chemical dispensing hoses in good working order

  Yes

  No

  N/A

• 25. Portable foamers in good working order

  Yes

  No

  N/A

• 26. Chemical or pipe work leaks identified

  Yes

  No

  N/A

• 27. Spray guns and foam nozzles in good condition

  Yes

  No

  N/A

• 28. Metering tips and pick-up tubes in good condition

  Yes

  No

  N/A

Plant And Equipment Condition

• 29. Rust marks

  None

  Yes

• 30. Mineral scaling

  None

  Yes

• 31. Surface pitting

  None

  Yes

• 32. Belt/white board discolouration

  None

  Yes

• 33. Chemical residue

  None

  Yes

• 34. Mould/mildew

  None

  Yes

Chemical Titrations

• Chemicals

Chemical

• Chemical

• Target

• Result

• Corrective Action

Task List

• Click to add

Task

• Issue

• Responsibility

• Agreed completion date

  Date

• Actual completion date

  Date

Budget Summary

• Click to add product

Product

• Product

• Volume used

• Price

• Total

Comments

• Comments (please mention section number if possible)

Conclusion

• Integra Representative (signature)

  Sign

• Site contact (signature)

  Sign