Information

  • DOCUMENT NUMBER

  • LOCATION

  • CLIENT

  • CONDUCTED ON

  • PREPARED BY

  • Select date

GENERAL SITE DETAILS

  • Documentation of original design available?

  • Crop Type?

  • Hectares?

PUMP SHED / ENCLOSURE

  • General Condition?

  • Suitable Lighting / Ventilation?

  • Ease of access around equipment?

  • PPE available?

  • Recommendations for Further Assessment?

WATER SUPPLY

  • Water Source?

  • Water Quality ( Visual Inspection)

  • Suitability of Pump Location?

  • Recommendations for Further Assessment?

PUMP STATION

  • Pump Type?

  • Pump Model?

  • Motor kW?

  • General Condition?

  • Bearing Noises?

  • Observed Water Leaks?

  • Condition / Suitability of Suction line and Footvalve

  • Condition / Suitability of NRV / Isolation Valves

  • Condition / Suitability of manifolds and Pipework

  • Water Meter Installed / Operational?

  • Condition of Electrical Components?

  • Recommendations for Further Assessment?

FILTRATION

  • Filter Type?

  • Model?

  • Secondary Filters Type?

  • Visual Inspection (Corrosion, etc)

  • Condition of Media / Discs / Screens?

  • General Operation (Auto, Manual)?

  • Suitability of Backwash Line?

  • Loss through Filters before cleaning (m)?

  • Loss through Filters after Cleaning (m)?

  • Recommendations for Further Assessment?

FERTIGATION

  • Fertigation Installed?

  • Type of Fertigation?

  • Condition / Suitability of connections and hoses?

  • Operation of injection Unit?

  • Fert Meter Installed / Operational?

  • Recommendations for Further Assessment?

Controller

  • Model?

  • Number of Stations?

  • Wiring / General Condition?

  • Operation of Controller/ Suitability for Project?

  • Recommendations for Further Assessment?

VALVES

  • Type

  • Brand

  • General Condition / Visual inspection?

  • Valve Numbering / Location

  • Recommendations for Further Assessment?

MAINLINES

  • Type?

  • Size?

  • Location / Operation of Isolation Valves?

  • Location / Operation of Air Valves?

  • Visible Signs Of Leaks?

  • Recommendations for Further Assessment?

SUBMAINS

  • Type?

  • Size?

  • Location / Operation of Air Valves

  • Location / Operation of Flush Valves

  • Recommendations for Further Assessment?

LATERALS

  • Type

  • Spacing

  • Flow Rate

  • Visible Signs of Leaks?

  • Location / Suitability of Flush Valves?

  • Recommendations for Further Assessment?

Other Items Needing Attention

SIGNATURES ON COMPLETION

  • Wayne Jennings

  • Customer

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.